WHY SHOULD SELF-INSURED EMPLOYERS AUDIT CLAIMS?
Many employers choose to self-insure their employees’ medical expenses to save money and maintain greater plan control by having a third-party administrator (TPA) manage claims processing. However, one unintended consequence of self-insuring is that the claims payer does not have financial incentive to control medical costs, which may result in the overpayment or erroneous payment of an employer’s claims. Given the ever-rising costs of healthcare, this can have a profound impact on a company’s bottom line. Depending on the size of the company, an error rate of 2% can translate to hundreds of thousands of dollars lost each year in overpayments and errors.
The best way to resolve this issue and keep healthcare expenses in check is to conduct periodic audits of your company’s claims data. This enables you to work with your claims payer to achieve a greater level of payment accuracy and to correct any errors in the process. We recommend an annual audit to avoid any potential two-year ‘no recovery’ trap.
HOW WE CAN HELP
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. This gives us the ability to detect both isolated and system-wide errors in payment of claims, yielding an unmatched level of accuracy during the audit. As a result, not only can you significantly improve your company’s recovery rate in overpayments, but you will be able to identify and correct root-cause errors to ensure even more savings going forward.
Healthcare Horizons performs comprehensive audits to identify root-cause errors and overpayment of medical claims, working with the client and the payer to correct errors and improve accuracy.
For clients who offer dental benefits to their employees, we provide extensive dental claims audits to test for overpayments and errors in paying claims against dental plans.
Healthcare Horizons can identify overpayments and errors in vision plans on behalf of employers who offer these benefits to their employees.
We offer auditing services specifically designed to test for accuracy in the payment of pharmacy benefits.
Learn more about the auxiliary and additional services we offer for our clients who need them.
Because the needs of every company are different, by offering this wide range of services to self-insured employers, Healthcare Horizons is positioned to customize and tailor our auditing services to each client to ensure they are receiving the personalized service they deserve. To learn more about our auditing services, contact us here.