HEALTH CARE AUDITS: CHALLENGES & OBJECTIVES
Paying claims correctly is essential to controlling costs, but it requires proper interpretation of complex benefit rules, verifying eligibility of dependents and proper Cobra administration. Controlling costs also requires monitoring providers who creatively code claims to qualify for higher payments or submit claims for work not done.
What to do? Hold your claims payor accountable and avoid repetitive errors through audit. Improperly paid claims can be corrected, contractual agreements modified to set standards for payment and to recover hard assets.
HOW IT WORKS
Allied Benefits partners with auditing services for self funded plans and these typically cover: Medical, Prescription, Vision and Dental Benefits and claims. The audits include dependent and Cobra eligibility as well as legal requirements and compliance in each area. Workers Compensation is reviewed with attention to the interplay between major health and worker’s compensation benefits.
Allied Benefits has partnered with TFG Partners to conduct the audits, after a vetting process that began 18 years ago. TFG Partners has clients from Fortune 500 to mid sized companies; some have had continuous contracts for almost 20 years.
WHY IT WORKS
There are six key reasons why self-insured companies choose our audit services:
- 100% Claims Audit
- Breadth of audit – Every claim is reviewed, every case of a specific error identified
- Depth of audit- Accumulated experience and technology allows an efficiency and consistency in identifying error types, results in clearly establishing value of errors.
- Customized software includes extensive audit algorithms utilized according to customers benefit design.
- Established working relationship
with all of the major health plan administrators
to identify processing errors and the software to provide all claim data subject to types of error to drive overpayment recoveries, maximizing savings and ROI
with their administrator, while working to create a continuous process improvement approach
used by your internal team
– Their partnership contract could provide that if they share a portion of the rewards part of the fees would be contingent upon actual results
NEXT STEPS
We would be pleased to introduce our partners to a joint discovery meeting with you for a discussion of the possibility of a mutual fit for working together.
