Benefit Errors Cost More Than 7 Million Dollars

Healthcare Horizons began the Lost Benjamins Award to highlight the importance of self-insured employers having annual audits of their paid medical claims. We share some of our audit findings to show how much money companies may be losing simply by not looking closely at their claims data.

Some errors may appear to be small dollar amounts and not significant. However, if the error is systemic, it may represent substantial overpayments in total.

In a recent audit, we noted several claims with missing benefit limitations at the line level. Due to a software configuration issue, benefit limits were not correctly applied to all applicable claim lines. The third-party administrator (TPA) responded that the system configuration issue had been corrected but prior paid claims had not been re-adjudicated. In terms of full impact remediation, the TPA reported that more than 6,000 claims were identified with a total recovery amount exceeding $7,000,000.00. There are more than 1,000 claims still requiring additional review. The total impact of our audit findings is expected to exceed $8,000,000.00 for the employer.

The impact that amount of money can have on both the company’s bottom line and the employees’ pockets is far-reaching. Are you SURE there isn’t a systemic error in your claims data costing your company millions of dollars?

Read our latest blog on systemic errors for more information.

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through its 100% Difference model, and recovering millions of dollars for clients’ bottom lines with uncompromising ethics and accuracy. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for the world’s largest self-insured employers, involving all national payers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for employers.