Many large employers choose to self-insure their employees’ medical expenses to contain healthcare costs and maintain greater plan control by having a third-party administrator (TPA) manage claims processing. However, one of the unintended consequences of self-insuring is that claims payers have no financial incentive to control costs and can unintentionally make errors that may range, on average, from 1 to 3 percent of total claims. Undetected errors cost self-insured employers money – potentially hundreds of thousands of dollars each year – that they must cover out of their own pockets.
Annual healthcare claims audits help keep healthcare expenses in check and ensure that employers are:
- Not overpaying claims or paying claims in error
- Identifying and eliminating systemic errors
- Recovering overpayments within the TPA’s timing limitations, avoiding the two-year ‘no recovery’ trap
- Fulfilling their fiduciary responsibilities as a self-insured employer
Why the 100% Difference?
A random sample audit will not look at every claim, possibly leaving thousands of dollars paid in error. Our comprehensive 100% Difference audit reviews 100% of claims paid, analyzing all claims data to find errors, improving recovery rates and identifying and correcting root-cause errors to ensure future savings.
“Random sampling misses over 90 percent of the errors caught by the methodology based on the 100-percent-of-claims analysis.”
Source: Professor Ronald Klimberg, Decision and System Sciences Department of the Haub School of Business, Saint Josephʼs University
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.
Why Healthcare Horizons?
Healthcare Horizons uses a proprietary set of algorithms that enables us to audit 100% of your claims, rather than taking a random sampling of claims. We use expert on-site eyes to detect both isolated and system-wide errors in payment of claims, yielding an unmatched level of accuracy during the audit. Our customized, flexible pricing options are designed to meet your needs and accommodate your TPA requirements.
To learn more, contact us here.