Our Approach

Healthcare Horizons is a leading expert in providing healthcare claims audit services, recovering millions of dollars for our clients with uncompromising ethics and accuracy. Since 1999, our comprehensive claims audits have been protecting the financial interest of some of the world’s largest self-insured employers, involving all national payers.

THE 100% DIFFERENCE: Every Claim. Every Possible Dollar.

The typical outdated methodology for claims auditing is by random sample, whereby auditors randomly select approximately 200-300 claims out of millions of transactions, examine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.

  • If the auditor encounters an error on a selected sample claim, it is virtually impossible to determine if the error is isolated or systemic in nature.
  • It is likely that significant one-off errors exist outside of the random sample selection.
  • It is often difficult to convince payers to issue settlements based on the results of a random-sample audit.

Healthcare Horizons’ comprehensive audits review every healthcare claim rather than a random selection. This approach yields much better 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 than random sampling allows. Additionally, our clients 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. You decide how hands-on you want to be.

Clear communication: We keep you informed. We take special care to alert you so recovery decisions are made with an understanding of member impact.

TPA relationship respected: Healthcare Horizons works with your TPA to identify errors, monitor collections, and help negotiate direct credits or settlements.

Leadership guides the way: You will receive hands-on involvement from Healthcare Horizons’ leadership for every audit.

Our No.1 Priority is Your Company’s Financial Interest

Our expertise works for you. Our expert data review process triggers creation of custom queries for “best probable error” selection, identifying more systemic errors and leading to increased future savings.

We 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. High return. We offer customized, flexible pricing options designed to meet your needs and accommodate your TPA require­ments. The return is more recovered dollars for your bottom line.

Until YOU are satisfied. We monitor the recovery efforts of overpaid claims by your third-party administrator until you are satisfied.

Satisfies fiduciary responsibility. Performing an annual healthcare claims audit protects your financial interest and fulfills the duty of care for your stakeholders, ensuring their trust and confidence.

If hindsight is 20/20, we give you perfect vision … leading to future savings. Call us today for a free audit rights assessment.

(800) 646-9987