Healthcare Horizons Consulting Group, Inc. is one of the most trusted and people-centered expert healthcare claims auditing firms in the nation, focused exclusively on self-insured employers. The company is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through its 100% Difference model, recovering millions of dollars for clients’ bottom lines with uncompromising ethics and accuracy. Healthcare Horizons is committed to putting people and relationships first, offering a streamlined process with high-yield return on investment, making the clients’ financial interest its number one priority. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for some of the world’s largest self-insured employers, involving all national and most regional payers. When ‘close enough’ isn’t, the unique 100% Difference approach yields more comprehensive results, leading to long-term future savings for our clients.
Our unique approach to healthcare claims auditing yields more comprehensive results than a standard random sample audit offered by most healthcare audit firms. Our audits result in the highest possible savings for our clients. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for employers across the country.
WHO WE ARE
In 1999, we discovered that along with rising healthcare costs, self-insured employers were unnecessarily exposed to a greater financial risk of overpaid healthcare claims given the TPA relationship model. This presented an opportunity to help companies audit and recoup money spent on claims in error. Our human-powered experience and expertise since that time has helped recover millions of dollars in erroneous claims and has allowed us to forge excellent long-term working relationships with some of the world’s largest companies and all major third-party administrators in the country. Clients can be secure knowing Healthcare Horizons believes in uncompromising ethics and accuracy, and are protecting their company’s financials. Our 100% Difference approach provides the greatest opportunity to identify and recover overpaid claims via a process that yields more comprehensive results than traditional random-sample audits. We do all this with sensitivity to your TPA relationship and make the process simple so you can focus on our core business and productivity. As a client, you will have access to our leadership, assuring you that your business is important to us.
We even help you know your audit rights and discover hidden clauses that can cost you money. We put YOUR business interest first.
WHAT WE DO (HOW WE DO IT DIFFERENTLY)
Healthcare Horizons audits 100% of claims in an effort to find every possible error and every possible dollar to recover. It is personal to us because our standards are not standard. Our comprehensive audit process is not a software solution. What our auditors do is more art and instinct to interpret the findings rather than relying on software algorithms only. Certainly, we use computer programs to streamline the process, but it is the keen experienced eye and expertise of our audit team that make Healthcare Horizons different. We have real people using database tools to identify errors that are then compared to the entire claims universe for additional occurrences. This process defines a true comprehensive audit since we do not just look at random sample claims. The personalization of our audit process ensures that we sort through gray areas of plan details and even find errors that can be fixed for future claims occurrences. Once our audits are complete, it is common for us to make plan benefit recommendations based on the error findings, leading to future savings.
Because our clients are not healthcare claims experts, we help them understand in plain terms what hidden issues are driving claims costs higher than necessary.
HOW THE 100% DIFFERENCE REPORT WORKS FOR YOU
We summarize the total dollars identified by issue. We provide details on each selected sample claim error and the dollar impact. We make recommendations regarding plan design, root-cause correction, and benefit changes.
WHY IT MATTERS (BENEFITS TO YOU)
The 100% Difference means we review every claim, identifying as many errors as possible, and helping recover every possible dollar. There is no incentive for a claims payer to control costs, and errors can range from 1 – 3% of total claims. A 100% audit helps keep healthcare expenses in check. Errors happen. People are not perfect, but Healthcare Horizons understands that the biggest error is ignoring what is left behind. As many as 1 in 10 bills paid by private health insurance contains mistakes. A sample audit will not find every mistake, leaving thousands of dollars unrecovered. And, it costs no more to do a full audit than a sample audit, so the real cost is what you leave on the table in unrecovered dollars. At Healthcare Horizons, we make it right by finding the source and correcting the problem. We put things back as they should be. Our expertise works for you by identifying and correcting systemic errors, leading to future savings. We also make it simple. We do most of the work, keeping you up-to-date along the way. It is our job to take a closer look, so you don’t have to. Low risk with high return is the result of our contingency audits. Finding errors requires skill and diligence, which comes from experience and true experts. We help our clients understand in plain terms what hidden issues are driving claims costs higher than necessary, and we always consider your TPA relationship.
Partnering with Healthcare Horizons means there is an opportunity on your horizon. Because we believe in uncompromising accuracy, we provide you complete and accurate information that allows you to make important business decisions, adding to your company’s bottom line. And, we work with your TPA to monitor overpaid claims until you are satisfied. Recovered dollars get deposited into your account, and then we deliver a report of recommendations to avoid future errors. If hindsight is 20/20, we give you perfect vision.
Since 1999, Healthcare Horizons has been focused exclusively on providing accurate and reliable audits for self-insured employers, working with our clients and with their third-party administrators (TPAs) to make sure claims are paid accurately. Using a process that was designed by our company’s founders, we use database tools coupled with a team of experienced auditors to identify and verify claims errors against an entire claims population – not just a sample. This process was perfected over many years and hundreds of client experiences, and we continue to innovate each day to be able to offer the most thorough, accurate, and efficient healthcare claims audits possible. The links below will tell you a little more about our business philosophy, our mission statement, our leadership, and our company affiliations.
Learn more about the four key principles that guide us as a company and help build long-standing trust with our clients.
Learn more about our primary commitment to protect the financial interests of our clients through accurate auditing and reporting.
Find out what some of our self-insured clients that rely on us for accurate claims auditing have to say about Healthcare Horizons.
Learn more about our affiliate companies.
Meet our leadership team, and learn more about how they ensure we are focused on our client goals and priorities.