Healthcare audits are the best way to ensure cost containment of health insurance plans. But we know that the last thing you want to do as a human resource manager or insurance broker – especially after open enrollment – is deal with the details of healthcare audits.
Good news! We do the work so you don’t have to! But what good are healthcare audits if all the mistakes aren’t found?
As many as 1 in 10 healthcare claims have errors.
Our Process
Random sample audits simply can’t find all the potential errors. We go beyond the random sample audit with our 100% claim audit approach. This may sound labor intensive, but don’t let that scare you off! Our process is time-consuming because it is thorough. But our audit professionals will do the heavy lifting.
- We sit down with clients after a contract is signed and talk through their goals. This, and providing us with your plan documents, is the majority of your time investment in the process. While we will always update you on findings and give you the opportunity to accept or decline next steps, you aren’t involved in the review of the claims. A member of our leadership team is involved with your audit from beginning to end.
- We use computer software to help analyze and identify patterns, but we don’t rely on just these algorithms. Our experts have been reviewing claims for a long time – some have been with our company for decades! In that time, they have developed an eye for red flags. This allows us to look for potential systemic errors as well as the one-off errors that occur in claims payment processing.
- TPA relationships are respected. Having an independent agency perform audits is prudent, and we know that your TPA is not the enemy. Mistakes happen. We work with your TPA to identify errors, monitor collections, and help negotiate direct credits or settlements.
What do you have to lose?
If you are the human resources benefits manager for a self-funded insurance plan, you know that keeping healthcare costs in check is important to not only employees but also your employer.
If you are the insurance broker, you can provide more value-add to the client by recommending audit services. You have an opportunity to show your client a significant recovery on overpaid claims so why wouldn’t you? Read our blog on the benefits of audit services for brokers and then reach out for a consultation.
Healthcare Horizons is the most people-centered, trusted healthcare claims audit firm in the nation, focusing exclusively on self-insured employers. To learn more about our audit difference, contact us at 800-646-9987.