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  1. Timing for Implementation Claim Audits

    When transitioning to a new third-party claim administrator or pharmacy benefit manager, conducting a comprehensive implementation audit at the 90-day mark is essential. The initial review conducted by medical claim auditing services provides independent verification to ensure that claim...

  2. Putting the Pandemic's Lessons to Work

    During the challenging times of the pandemic, employer-sponsored health insurance plans faced significant challenges and disruptions. It is paramount to frequently review claims in a medical and Rx audit to steer towards a more resilient and prosperous future. Despite the routine data reporting...

  3. Optimize to Run Better Claim Audits

    Companies that handle medical and pharmacy claim processing for employer self-funded plans must undergo periodic audits, ensuring regulatory compliance and financial oversight. Medical claims auditing is becoming increasingly frequent each year and is vital for overseeing the complex process of...

  4. The Many Reasons to Audit Health Plan Claims

    Containing costs and serving members better (and equally) are among the many excellent reasons to review medical plan claims with a healthcare audit. Nothing compares to an auditor's independent review of your claim payments. It produces factual reports that cover every aspect of your claim...
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