WHY AUDIT? Regular audits keep costs in check.
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. It is crucial that self-insured employers conduct annual healthcare claims audits because one of the unintended consequences of self-insuring is that claims payers have no financial incentive to control costs. Errors can range, on average, from 1 to 3 percent of total claims, a cost that self-insured employers must cover out of their own pockets, potentially translating into hundreds of thousands of dollars lost each year.
Regular audits help keep healthcare expenses in check and ensure that employers are:
- Fulfilling their fiduciary responsibilities
- Not overpaying claims or paying claims in error
- Identifying and eliminating systemic errors
- Recovering overpayments within the TPA’s timing limitations, typically a two-year ‘no recovery’ trap
The 100% Difference
Your current TPA service agreement may limit you to a random sample audit, which we will accommodate if necessary. However, a random sample audit will not look at every claim, possibly leaving thousands of dollars paid in error. Our comprehensive audit reviews 100% of claims paid, analyzing all claims data to find errors. As a result, you significantly improve your company’s recovery rate in overpayments, and we identify and correct root-cause errors to ensure future savings.
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.
We offer a comprehensive suite of pharmacy benefit auditing services.
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.
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.