“We wanted to let you know that we settled all the outstanding audits that you performed for the County. It was a long process that centered around your analysis and tracking credits to our monthly billings from the TPA’s recovery efforts. The TPA agreed to pay approximately $1 million for the three years of audits. We just wanted to let you know that your work and follow-up support greatly helped us in the negotiation discussions. We thank you for your audit work for the County and your continued support.”
— Large county government client
This kind of response from our satisfied clients is why we continually preach the importance of performing an annual healthcare claims audit. Since 1999, our comprehensive claims audits have protected the financial interests of some of the world’s largest self-insured employers. Our comprehensive 100% Difference audits yield much better results than typical random sample audits because we identify both isolated and systemic errors and assign actual dollar impact to those errors. As a result, employers can recover significantly more in overpayments than random sample audits allow.
When engaging an audit firm, some key points to consider:
- Who is in charge during the audit? Healthcare Horizons ensures that you determine which claims to recover. You decide how hands-on you want to be.
- What is the communication process? Healthcare Horizons will keep you informed throughout the audit process. We take special care to alert you so recovery decisions are made with an understanding of member impact.
- Will my TPA relationship be harmed? Healthcare Horizons works in cooperation with your TPA to identify errors, monitor collections, and help negotiate direct credits or settlements.
- What is the level of expertise? With over 26 years of experience, Healthcare Horizons’ expert data review process triggers creation of custom queries for “best probable error” selection. This in-depth analysis identifies more systemic errors and leads to increased future savings.
- Who will help me recover overpaid claims? Healthcare Horizons will monitor the recovery efforts of overpaid claims by your third-party administrator until you are satisfied.
Cure the Benefits Blues by performing an annual, 100% Difference comprehensive audit on healthcare claims, which can uncover thousands of dollars (or more) that can be recovered for the self-funded employer.
Every Claim. Every Possible Dollar.
To learn more about our approach to healthcare claims auditing, visit Healthcare Horizons or contact us at hhadmin@healthcarehorizons.com to discuss a free healthcare claims audit assessment.
Randy King is president of Healthcare Horizons Consulting Group, Inc. – performing healthcare claims audits since 1999. Trusted partner. Uncompromising accuracy. Superior personal service. Recovering millions of dollars for some of the world’s largest employers.