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Escalating medical and prescription costs have long been a concern for employers funding their benefits plans. As a result, plan sponsors increasingly work with medical claim auditors to doublecheck claim payments. This surge in demand for oversight and cost review has led to a substantial increase in the utilization of healthcare auditing companies as sponsors strive to manage their benefits plans more closely. Today, health plans are exponentially increasing requests for audit services as they grapple with the complexities of conta... more

Benefit plan claim payments, especially costly ones for health plans, need active oversight to watch for errors. Prescription and medical claims auditing is an excellent way to double-check payment accuracy and the work of claim administrators – third-party processors and pharmacy benefit managers. When   large employers self-fund benefit programs and outsource claim administration, there is significant financial exposure. In at least two recent instances, large corporations have gone to court agai... more

Cost and care management are dually significant priorities for self-funded medical and pharmacy plans. There are thousands of variables to consider for everyone involved in their management. That's why reviewing claims with a medical and RX audit is crucial. Auditors equipped with advanced software can provide an independent analysis. It's excellent oversight for third-party claim administrators and pharmacy benefit managers. Their systems are sophisticated and accurate, but things can slip through the cracks. When auditors make... more