The 100% Difference: Every claim. Every possible dollar.
The typical outdated methodology for claims auditing is by random sample, where auditors select approximately 200-300 claims out of millions of transactions, examine those claims for errors based on predetermined criteria and extrapolate the results across the entire range of claims. While this approach may be considered standard practice when handling so many claims, it also carries a margin of error that can work against the company.
Drawbacks to random sample audits include:
- Impossible to determine if errors are isolated or systemic.
- Likely that significant errors exist outside of the sample selection.
- Difficult to convince payers to issue settlements based on results.
Healthcare Horizons’ comprehensive audits review every healthcare claim – with expert eyes – rather than a random selection. This approach yields improved results because we identify both isolated and systemic errors and assign actual dollar impact to those errors, making a much stronger case to the payer. As a result, employers can recover significantly more in overpayments and can correct systemic issues, preventing future claims paid in error.
The Healthcare Horizons promise: People first.
- You are in charge. You determine which claims to recover.
- Clear communication. Recovery decisions are made with an understanding of member impact.
- TPA relationship respected. We work with your TPA to identify errors, monitor collections and help negotiate direct credits or settlements.
- Leadership guides the way. Healthcare Horizons’ leadership is involved in every audit.
Your company’s financial interest is our No. 1 priority.
- Our expertise works for you.
- We make it simple.
- Low risk. High return.
- Until YOU are satisfied.
- Fulfills fiduciary responsibility.
If hindsight is 20/20, we give you perfect vision … leading to future savings.
Contact us for a free audit rights assessment.