If the coronavirus pandemic did anything for health plans, it was to confirm the value of medical claims auditing. Independent oversight of medical and pharmacy claim payments is vital in verifying accuracy and flagging mistakes. No doubt, error rates are low, and many processor agreements contain provisions for self-policing. But only the watchful eye of a skilled auditor can confirm the promises are being kept. Given the dollar volume of medical claim payments, they are material to the bottom line in many large employers that self-fun their employee benefit plans.

If you operate based on assumptions and they are met, there's still reason to audit claims. Driving the error rate down to zero is a stretch goal; the closer you get to it, the better. Even before the pandemic and more after it, plans are choosing to keep claims auditors on a continuous retainer. They review claim payments monthly and report the findings. If you're working in-house at a plan sponsor, imagine the value of factual data about plan performance, updated monthly. It helps avoid million-dollar problems by catching things in their infancy and correcting them.

One of the most significant opportunities comes during the pre-audit meeting. Let your auditors know if you've been trying to understand more about specific areas of your claim administration. They can zero in on those areas with a thorough eye and report their findings. One of the biggest reasons to go with a specialist claim auditing firm is their more profound expertise. Because their people are auditing claims daily at all the major processors, they immediately pick up on anything new. Knowing they arrive with deep knowledge that will benefit your plan significantly gives you peace of mind.

The progression of claim reviews from the random samples of yesteryear to the 100 percent audits of today is also notable. The accuracy is unprecedented when every claim is reviewed and checked against hundreds of data points. When your plan's provisions are loaded into the auditor's system along with your specific questions, the report you'll receive is impressively thorough. The value of double-checking payments increases even more during rapid change. The recent pandemic is an excellent example, as new treatments and testing came onto the market at wildly varying prices. 

Company Name- TFG Partners, LLC

Address- 437 Grant St #1020, Pittsburgh, PA 15219

Contact Number- (412)-281-2228