Keep Medical Claim Payments More on Track
Allowing someone else to pay your bills is giving them significant responsibility. It’s precisely what happens when self-funded benefit plans hire third-party claim administrators. As a result, it’s easy to see why independent medical claim auditing becomes important. It’s a way for plan sponsors (usually large corporate or nonprofit employers) to oversee their payments. With many plans spending millions of dollars monthly, there is every reason to review payments for accuracy. Audits aren’t a drain on your budget because they often find recoverable errors worth more than their price.
When you comprehensively audit medical and pharmacy claims, seeing where the mistakes occur is enlightening. They may be in the expected areas or completely different spots. Most outsourced claim administrators keep error rates in the low single digits. Still, the dollars are significant in medical and pharmacy claims, so even a one or two-percent error rate adds to substantial sums over time. It’s also fairer to members when claims are paid accurately because it helps treat everyone equally. Plans have a fiduciary responsibility to spend dollars wisely. So, it’s a member service benefit along with cost containment.
No two plans and their provisions are alike, so audit setup is crucial. Experienced claim auditors will closely review your plan documents and adjust their systems accordingly. They must bring knowledge to the table based on work for others and then change the audit to focus on your plan’s specific needs. Don’t hesitate to request particular review areas in the pre-audit meetings or correspondence. If you manage an employer-funded health or pharmacy plan and find an excellent auditor, stick with them. Then, when you compare reports for different periods, they follow a format.
A couple of large corporate plan sponsors have recently made news by going to court in a dispute with their claim administrators. Customarily, they are large health plans accused of significant error patterns that have driven up costs. In some cases, the allegations appear based on promises not kept. In all cases, the plans were billed more than they felt they should be, and are seeking relief before a judge. It’s expected that behind-the-scenes talks hit a dead end before lawyers were consulted and lawsuits filed. It is another reason to keep tabs on your plan’s claim payment costs.
Company Name- TFG Partners, LLC
Address- 437 Grant St #1020, Pittsburgh, PA 15219
Contact Number:(412)-281-2228
