For self-insured companies that offer vision care benefits for their employees, Healthcare Horizons can conduct comprehensive vision audits to verify and improve accuracy in payment of claims according to plan benefits.
WHAT WE TEST FOR
Once we obtain the necessary files and data from the clients, Healthcare Horizons will conduct a thorough review to look for errors while testing the claims against information provided by the third-party administrator. Among many other factors, we look closely at the following:
- Vision exam and hardware coding accuracy
- Benefit maximums
- Patient responsibility (deductibles, coinsurance, copays)
- Duplicate payments
- Coordination of benefits
Through the course of vision audit, we will look not only for incidents of error and overpayment, but also for systemic, root-cause issues that may create patterns of overpayment. In this way, not only are we able to help our clients recover more in overpayments, but we can also make recommendations for correcting root-cause issues, resulting in significant savings over time.
THE AUDIT REPORT
Once we have completed our review, we deliver a final report to the client revealing the areas we tested and our findings, an accounting of all erroneous claims detected, and an explanation of any root-cause issues that were identified, along with recommendations for correction.
In every audit we conduct, Healthcare Horizons goes to great lengths to ensure our clients are receiving the most accurate audit results possible, so that they can recover and save the maximum possible amounts. To learn more about our vision audit services, contact us here.