Podcast

scary zombies in window trying to get inside

The Scary Alternative to Medical Claims Audits

Medical claims audits aren’t scary, but the results of not performing them can be frightening! Audits are best practices in the healthcare industry, especially for self-funded health plans. Comprehensive audits involve a thorough review of claims to ensure they are accurately paid on behalf of the self-insured client.

Still hesitant about conducting medical claims audits…

What’s the Worst That Could Happen?

The Alien Abduction Claim: An employee submits a claim for medical expenses incurred during an alien abduction. The auditor, being a rational person, dismisses the claim as a prank. However, the employee insists that the aliens had performed a complex procedure and provides evidence in the form of a shiny metal implant.
Time Traveling Employee: Imagine your employees submitting claims for tickets to the future or the past, citing “historical research” as the reason.
The Ghostly Illness: An employee submits a claim for treatment of a mysterious illness that only manifests when the employee is alone at night. The auditor, unable to verify the claim, recommends a consultation with a paranormal investigator.
Furry Family Members Submit Claims. Picture your employees submitting claims for their cat’s laser eye surgery or their dog’s dental cleanings.

Okay, so these scary scenarios are a bit far-fetched.

But the point is, finding errors in your medical claims ISN’T the worst thing that can happen. The WORST thing that can happen is that you DON’T find the errors – costing your company thousands, if not millions, of dollars. Addressing issues now can save money when the same error repeats year after year after year.

Why Audits Are Healthy – not Scary – for Self-Funded Plans

Identifying Errors and Inefficiencies: Audits can help uncover errors or inefficiencies in your claims processing that may be costing your plan money. Healthcare Horizons’ comprehensive audits review every healthcare claim and specifically target claims to review onsite with the carrier, 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. By identifying these issues, you can take steps to correct them and prevent future losses.
Ensuring Fiduciary Responsibility: Legal experts are sounding the alarm about growing compliance risks as more healthcare costs are funded by employee contributions. This raises the importance of protecting the fiduciary responsibilities of employers. We believe one of the most fundamental elements in corporate oversight is sadly lacking in healthcare benefits administration at many companies – effective audit policies and practices. Many self-insured companies fail to have an annual audit of paid medical claims. Our comprehensive audit provides assurance that companies and employees’ healthcare costs are not being inflated by payment errors and abusive claims.
Improving Plan Performance: Following best practices in healthcare claims management ensures the plan matches client intent, provides oversight of the administrator to ensure accuracy, implements cost-containment measures achieved by correct payment processing and identifies areas to eliminate fraud, waste and abuse.

Healthcare Horizons can help you avoid common and hidden nightmares by providing a streamlined and efficient audit process. We also return overpaid dollars to your company bottom line. Don’t let fear or uncertainty hold you back. Contact us today to learn more about how we can help your self-funded health plan.

Curious about the types of discoveries we make in our audits? Check out our Lost Benjamins chronicles if you want to read something really scary!

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through our 100% Difference model and recovering millions of dollars for clients’ bottom lines while upholding the highest ethical standards. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for some of the world’s largest self-insured employers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for our customers.

Negotiating Now Means 2025 Healthcare Savings!

Don’t Miss Your Negotiating Window!

Attention businesses with self-funded healthcare plans! While your team may be enjoying some well-deserved vacation time, third-party administrators (TPAs) and benefits managers are negotiating Administrative Services Only (ASO) agreements for 2025. This is a critical time to ensure your company gets the best possible deal, especially when it comes to audit rights.

Audit Rights are for Your Protection.

Self-funding healthcare plans offer cost-saving benefits, but they also come with fiscal responsibility. You’re on the hook for claims paid by the administrator to providers. Strong audit rights allow your company to verify the accuracy of those claims, potentially uncovering errors or extra fees and saving you significant money. But if you don’t have the appropriate audit rights, you could get burned and your savings washed away.

Don’t Bury Your Head in the Sand!

Many companies have no idea they should be auditing their claims data. HR executives and benefits administrators might think their broker or benefits consultant manages everything – but that’s a dangerous assumption. The responsibility for identifying and correcting errors falls on you.

During negotiations, ensure that your ASO agreement does not restrict your ability to audit the payer’s work. Here’s what you need to do:

Review your current ASO agreement: Understand your existing audit rights and identify any limitations.
Research industry standards: Benchmark your current agreement against what other companies are negotiating.
Negotiate for comprehensive audit rights: Push for the ability to analyze all claims data, select targeted claims for review versus random sample selection, and review provider contracts.

Get Help Protecting Your Bottom Line!

Healthcare Horizons is here to empower businesses like yours in your audit agreement negotiations, as well as with your comprehensive healthcare plan audits. We offer a complimentary ASO audit language review and provide recommendations to help you negotiate the best audit rights. This can be a valuable starting point for ensuring that your plan isn’t overpaying for healthcare benefits!

By acting now, you can ensure your ASO agreement delivers on its cost-saving promise for 2025. Don’t miss out – negotiate for robust audit rights, protect your company’s bottom line, and take advantage of Healthcare Horizon’s free audit language review. Contact us today at www.healthcarehorizons.com or 800-646-9987.

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through our 100% Difference model and recovering millions of dollars for clients’ bottom lines while upholding the highest ethical standards. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for some of the world’s largest self-insured employers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for our customers.

hand wearing white glove holding money from healthcare savings

White Glove Service Maximizes Your Healthcare Savings

There’s a hallmark of excellence that signifies the ultimate in care and attention: white-glove service. It is more than getting the job done. It’s about exceeding expectations and creating a truly personalized experience.

At Healthcare Horizons, we embody the spirit of white-glove service. We go beyond simply meeting your needs. We actively exceed expectations at every turn. But what does that mean in practice?

Translating White Glove Service into Action

Anticipating Your Needs: We understand that time is money. That’s why we go beyond simply identifying problems in your medical billing. We take a proactive approach, constantly looking for systemic issues and implementing solutions to prevent them from recurring. This ensures you don’t face the same headache twice.

Your Success is Our Priority: We genuinely care about your bottom line. We work tirelessly to help you save money on your medical payments by identifying errors and discrepancies in your payments. Every dollar we recover for you is a dollar that goes back into your pocket. Think of it as reinvesting in your business.

A Customized Approach: A one-size-fits-all approach doesn’t cut it. We understand that every client has unique needs. That’s why we customize our audits to fit your specific situation. We take the time to understand your business and tailor our services accordingly. This ensures you get the most out of our expertise, addressing your specific challenges and maximizing your savings.

Transparent Communication: Audits can be stressful. Our white-glove service insists on clear and consistent communication throughout the process. We keep you informed of the progress, explain findings in an easy-to-understand manner, and are available to answer any questions you may have. This transparency fosters trust and empowers you to make informed decisions about your reimbursement options.

Following Through with Excellence: Our job doesn’t end with the audit. We believe in white-glove service that extends beyond the initial process. We are here to support you every step of the way. After your audit is complete, we will follow up to monitor your recovery activity, answer any questions you may have, make recommendations, and ensure you have the resources you need to move forward.

A Committed Partner to Your Success

We strive to create an exceptional client experience that builds lasting relationships. At Healthcare Horizons, your needs are our top priority. We understand that navigating the world of healthcare claims audits can be complex and overwhelming. That’s why we become your hands-on team, guiding you through every step. We collaborate with other parties involved in your plan, but our ultimate responsibility lies with you. Your success is our focus – that’s the white-glove difference we offer.

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through our 100% Difference model and recovering millions of dollars for clients’ bottom lines while upholding the highest ethical standards. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for some of the world’s largest self-insured employers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for our customers.

word joke in circle with line through it

There’s Nothing Funny about Skipping Claims Audits

Skipping Audits is No Joke

Chicago is known for a lot of things – hotdogs, deep-dish pizza, frustrated baseball fans and even wind. However, another aspect it’s known for is its history of comedy. With The Second City and a multitude of improv halls, it only makes sense that this year’s SHRM conference in Chi-town is featuring many well-known comedians as star-studded bonuses to the networking conference.

After you see Jay Leno or Sherri Shepherd, we invite you to stop by and see us to learn more about why skipping healthcare claims audits of your paid medical claims is no laughing matter.

Past attendees indicate that one of the reasons they attend the SHRM conference is to discover cost-saving initiatives that are important to their companies. Human resource executives are continually looking for ways to improve benefits without increasing expenses to the employer or employees. Since health insurance is consistently the most important benefit desired by employees, it’s important for HR directors and benefits consultants to find innovative and sustainable ways to keep costs manageable. A comprehensive claims audit is one tool to accomplish that goal.

Top 4 Benefits of a Comprehensive Claims Audit

Reviewing medical claims data is the only way to know for sure if your plan is administered correctly. Comprehensive audits include a review of the entire data set so that egregious errors aren’t missed (image if a random sample audit missed a 100-thousand-dollar mistake). By having annual audits, you ensure that your company is:

Not overpaying claims or paying claims in error
Identifying and eliminating systemic errors
Ensuring recovery of overpayments within the TPA’s timing limitations
Fulfilling the fiduciary responsibilities as a self-insured employer

Comprehensive claims audits have one overarching goal: to return dollars to your bottom line. You would not accept overpaying your credit card bill or allowing bank errors to go unresolved. And you would most assuredly hold someone accountable if processes were systemically in place that caused mistakes. The same is true for your self-funded medical plan. Every time you overpay for medical expenses, your plan loses money, and your employees are negatively impacted – both through the types of benefits you can continue to offer and through paying more in premiums or co-pays.

Read more: Top 10 Audit Questions

Stop the cycle! Let’s talk about your company’s needs. Call us at 800-646-9987 to schedule a meeting at the SHRM conference or visit us at booth 1557 to ask your audit questions and enter to win a unique prize!

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through our 100% Difference model and recovering millions of dollars for clients’ bottom lines while upholding the highest ethical standards. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for some of the world’s largest self-insured employers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for our customers.

Don’t let unanswered questions halt your medical claims audit.

Medical claims audits are valuable resources to protect one of the biggest expenses in your business. We are happy to review the audit rights language in your administrative services agreement at no charge to help determine the correct audit approach for your company, as well as make suggestions for future negotiations with your TPA. Don’t pay more in claims than you are required to pay! Get your questions answered and start the audit process today!

Are you going to be at SHRM 2024? Call us at 800-646-9987 to schedule a meeting or visit us at booth 1557 to ask your audit questions and enter to win a unique prize!

stethoscope over lines showing rising healthcare costs

Control Rising Healthcare Costs by Reviewing Data

Rising Healthcare Costs Can be Tamed

In a recent blog we talked about the impact of inflation on businesses and how prudent executives are seeking ways to save money that will then help fund desired employee programs. Unfortunately, as reported in this SHRM article, rising healthcare costs are outpacing inflation.

The cost of medical care benefits in the U.S. is projected to increase about 8.9 percent in 2024, compared with 8.2 percent in 2023.

Medical costs for employer-sponsored plans, which includes improved technologies, overprescription of treatments or lack of preventative care, continue to outpace inflation, rising on average between 6.8 percent and 7.3 percent.

Some suggestions in the article to flatten the trajectory of the price increases include telehealth options, more well-being services and taking stock of existing benefits. Before any new policies or options are implemented, however, we recommend a comprehensive review of self-funded healthcare claims payments. Only with a professional review can you fully aggregate and analyze health data to identify waste, abuse, or just plain mistakes. Health analytics can then be used to drive process improvements and eliminate ineffective interventions that inflate costs more than necessary.

Find Multiplying Systemic Errors

There is no better time than now – the start of a new year amid soaring costs – to schedule a professional audit of last year’s healthcare claims data. Not only will a healthcare claims audit find instances of overpaid or misallocated claims, but a comprehensive audit will correct any systemic issues that could be carried into 2024. If imbedded problems are not addressed, not only will a self-funded company pay more in increased costs from providers, but the company will also pay more in erroneous claims. If left unchecked, those incorrect claims will keep occurring and the lost dollars will keep growing.

Systemic issues can include abusive and fraudulent practices or inadvertent errors. Fraudulent practices are those that involve intentionally billing at an incorrect rate.

Upcoding – This involves systematic billing for services at a higher rate than what was actually provided. For example, billing for a 30-minute physician office visit when the patient only received a 15-minute visit.
Unbundling – Breaking what should be one billing code for a group of procedures into multiple individual codes to maximize reimbursement. This leads to inflated charges.
Medical necessity errors – Billing for services that aren’t medically necessary for the patient’s condition or care plan. Services should meet insurance criteria for necessity.

Other systemic errors occur due to incorrect information being given to claims processors, leading to ongoing data entry mistakes.

Incorrect coding – Using the wrong billing code for a service rendered, resulting in incorrect payment rate. Coders may consistently enter certain services incorrectly.
Coordination of benefits errors – Failing to properly coordinate claims with secondary insurers results in overpayment from the primary insurer. Information systems may have incomplete secondary payer data.
Eligibility verification failures – Providing services without confirming active health plan enrollment and eligibility, risking denial of claims. Systematic verification checks may be inadequate.

The Cost of Waiting is High

Waiting to find the errors in your healthcare claims data is costing your company money. That money could be passed on to plan participants through reduced deductibles. Or the savings found in duplicate payouts, as an example, can be returned to your bottom line and help fund other initiatives. Costs may be rising, but that doesn’t mean you are without recourse. Contact Healthcare Horizons for an initial review of your administrative plan to determine your best next steps to minimize the impact of rising costs.

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through our 100% Difference model and recovering millions of dollars for clients’ bottom lines while upholding the highest ethical standards. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for some of the world’s largest self-insured employers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for our customers.

inflation letters cutting through a hundred dollar bill

Fight Inflation in the New Year

Don’t Let Inflation Impact Your Healthcare Offering

Every year, saving money or better managing finances is in the top five on New Year’s resolutions lists. Businesses are no different. Your company may have just finished its budget review, or you may be planning during Q1, but the goal is the same: end 2024 with more profit than last year.

If the only things factored into your success were your income and expenses, it would be easy to ensure that your end-of-year number would be positive. But, just like our home finances, your business’ bottom line is impacted by external pressures, like unexpected maintenance expenses, personnel leaves of absence or even federal regulations. The biggest pressure facing families and corporations, however, is inflation.

Inflation Impacts All Aspects of Business

Some economists estimated an 8% inflation rate for 2022 and a 4.5% rate for 2023. While 2024 rates are expected to level off to around 3%, the impact of the significant rise in prices on goods over the past three years will be felt for years to come. Salaries will continue to be adjusted to allow employees to afford increased prices on groceries, utilities and rent. More dollars will need to be allocated to healthcare as well, by both individuals and companies. Fortunately, there are steps benefits administrators or human resources professionals can take to lessen the impact on a company’s bottom line.

Audits Drive All Solutions

To reduce expenditures from your self-funded health care plan, you must understand how your funds are administered. To do this, you need to audit your healthcare claims fully. Comprehensive audits that review 100% of your healthcare claims provide valuable insights, including patterns of inaccurately billed claims, and identify the best way to reclaim overpaid dollars. Transparency helps policymakers develop effective strategies to combat inflation in healthcare payments.

Once armed with the information garnered through your audit, you can use your findings to negotiate lower rates with providers, thereby reducing overall healthcare costs. As you find cost savings through better rates and reclaimed dollars, you can then advocate for policy change through implementation of targeted cost-containment measures, such as prior authorization programs or utilization management initiatives, which can further mitigate the impact of inflation.

It’s important to note that healthcare claims audits are not a one-size-fits-all solution to inflation. However, when implemented effectively, they can be a valuable tool for protecting against rising healthcare costs and ensuring that resources are used efficiently and effectively.

This new year, make your top business resolution to boost the fiscal health of your self-funded health care plan. Call today for a complimentary review of your current administrative plan and learn how our audit process can help your company’s bottom line.

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through our 100% Difference model and recovering millions of dollars for clients’ bottom lines while upholding the highest ethical standards. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for some of the world’s largest self-insured employers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for our customers.

Beware healthcare reimbursement overpayment: A Halloween horror story

Imagine if you will, an employee has surgery for a freak chainsaw accident. Assisting in the patient’s care are a masked surgeon, an anesthesiologist with a large wart on the nose, a post-op nurse (who happens to always have a broom with her) and administrative staff who appear to have dead eyes. The total cost for the procedure is $100,000. But unbeknownst to you, your third-party administrator paid out a total of $150,000. That’s $50,000 of overpayment lost to you and your company’s bottom line.

This story, while (possibly) fictional, is based on real-life billing errors. Healthcare reimbursement overpayment is a real and growing problem. In fact, according to a 2019 study by Humana, overpayments were a significant contributor toward the estimated $265 billion in wasted healthcare spending.

With a growing number of medical claims each year, there quite simply will be more mistakes. The 1-3% error rate doesn’t change so the numbers rise. There are several factors that can contribute to healthcare reimbursement overpayments. The type of mistakes include:

Coding errors: Coding errors can occur when healthcare providers use the wrong codes to bill for services. This can lead to overpayments for services that were not actually provided or for services that were provided at a lower level than what was billed.
Duplicate billing: Duplicate billing occurs when healthcare providers bill for the same service multiple times. This can happen accidentally or intentionally.
Fraud: Fraud is another leading cause of healthcare reimbursement overpayments. Fraud can involve healthcare providers billing for services that were never provided, falsifying medical records or upcoding services.

Turn an Overpayment from a Trick to a Treat

Medical claim overpayments can dress up as something innocent and if you don’t know what to look for, you won’t find the mistake. Fortunately, we are experts at unmasking the imposters. Our comprehensive review process means that we find more errors than the random sample method. Random may be okay when reaching in the candy bowl, but it means you could be missing a big reimbursement when reviewing your healthcare claim payouts! Don’t you want to find that missing $50,000?

Halloween is a time for fun and spooks, but it’s also a time to uncover the mistakes in your healthcare claims payments and make plans to try and keep them from happening again. Let us take the scary out of your self-funded health plan. We can help you with your audits and review your annual agreements to help protect your investment.

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through our 100% Difference model and recovering millions of dollars for clients’ bottom lines while upholding the highest ethical standards. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for some of the world’s largest self-insured employers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for our customers.

like many rabbits in a forest, systemic errors can multiply quickly

Systemic Errors Multiply Faster than Rabbits

Have you ever had rabbits in your yard? One or two may seem harmless, but left unchecked, they will quickly multiply and destroy your landscaping, garden and grass, leaving you with a big bill to fix the mess. Systemic errors in a self-funded health insurance plan work the same way. One error that costs your company $100 won’t impact the bottom line significantly. But that same $100 error, committed numerous times over an extended period, will cost your company a lot of money…sometimes even millions of dollars!

How Systemic Errors Occur

Self-funded health insurance plans are popular for businesses, specifically those with a large number of employees, because they can lower costs, provide more flexibility on coverage and include greater control over benefits. However, because of their scope, self-funded plans can be more susceptible to systemic errors.

Systemic errors are mistakes that occur in the underlying systems and processes of a plan. They can be caused by a variety of factors, including benefit plan setup errors, incorrect coding edits, abusive or fraudulent billing, inadequate processor training and outdated technology.

Some of the most common systemic errors in self-funded health insurance plans include:

Incorrect eligibility determinations, leading to employees being denied coverage or receiving incorrect benefits.
Inaccurate claims processing, resulting in delayed or denied payments, or in incorrect amounts being paid.
Fraud and abuse are intentional errors that occur when employees file fraudulent claims or providers bill for services that were not rendered.

The Fix for Errors is in Your Data

Employee complaints are one red flag that errors are occurring in your health insurance claims. Health insurance is an area that your employees need to trust will be accurate and available. When claims repeatedly are denied or employees must pay a larger than expected out-of-pocket share, there may be an unnoticed error in processing.

Finding those errors happens through a careful analysis of claims data sets. These reviews are done through audits. In our comprehensive audits, we work with you to audit your third-party administrator (TPA) and identify potentially incorrect claims. By analyzing complete data sets, and not just random samples, it is possible to identify patterns that suggest the presence of systemic errors (this also catches one-off errors!). For example, if a particular type of claim is consistently denied, this may indicate a code was incorrectly entered when the system process was set up. Once we flag suspicious claims, we collaborate with you – our client – to determine which claims to assess fully. Then we go to work to recover overpaid dollars and return them to you.

Systemic errors can be sneaky because when the error occurs it might not be noticed, either due to the smaller dollar amount error or confusion over medical claims language. This stealth behavior underscores the need for regular outside audits of your self-funded plan by experts. Only with regular reviews can you be sure that your plan is being administered correctly, employees are receiving their full benefits and your plan is not overpaying for care.

It’s time to get the rabbits under control. Contact Healthcare Horizons to begin managing your healthcare expenses with a comprehensive audit.

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through our 100% Difference model and recovering millions of dollars for clients’ bottom lines while upholding the highest ethical standards. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for some of the world’s largest self-insured employers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for our customers.

Your Wake-Up Call

It is important that human resources leadership and corporate counsels be mindful of the growing efforts by disgruntled employees and employee advocacy groups to utilize ERISA regulations to initiate class-action lawsuits related to alleged failures to appropriately manage medical costs. Motivated by the escalating impact on employees and their families from annual increases in health insurance premiums, deductibles, co-insurance, and other cost-sharing obligations, legal actions are being pursued. These actions may target both self-insured employers and their third-party administrators (TPA’s). Horror stories abound.

No Surprises Act Requires Follow Up

Healthcare Horizons continues to find various overpayments, including systemic issues, that if reported in a legal complaint would appear quite egregious, including out-of-network surprise bills being paid 100% of billed charges. The No Surprises Act went into effect in January 2022 and established processes to address egregious out-of-network claims, including arbitration if necessary. As we have reported many times in our Lost Benjamins Award materials, overcharges and overpayments adversely impact employers and employees.

A recent study reported that employees contributed 22% of their health plan’s premium costs in 2021. As medical cost-sharing provisions continue to rise, resulting in employees paying greater out-of-pocket expenses, as much as 15-25% of an employee’s annual compensation may be consumed by healthcare expenses. Thus, it should be no surprise there is a growing focus on the integrity of such obligations. This environment has the attention of plaintiffs’ attorneys willing to pursue class-action lawsuits on a contingency basis.

Comprehensive Audit Meets Fiduciary Minimum Standard of Care

If an employer has not had an audit performed by an independent expert, it may face allegations of failing to meet a fiduciary’s minimum standard of care. Reliance on the employer’s insurance broker or TPA to meet this obligation may prove unfounded. If any audits are performed, they most likely are random sample audits on all plans, not a single employer’s plan. Such audits miss over 90% of overpayment amounts and can miss systemic errors readily detected by 100% claims audits.

Human resource leaders should act immediately to ensure their company does not remain exposed to this increasing risk. Engage a qualified expert to perform a 100% audit of medical claims.

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through our 100% Difference model and recovering millions of dollars for clients’ bottom lines while upholding the highest ethical standards. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for some of the world’s largest self-insured employers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for our customers.