Do you conduct regular audits of claim payments made by your third party administrator? If not, why not?
Think about this for a moment: employers that self-insure their group health plan spend millions of dollars each year, yet that spending occurs in a "black box" at your third party administrator. No other area of your organization's expense structure operates this way; there's always an audit trail. But not in the area of group health plan expenditures.
That's a fact which, if your CFO gave it some thought, he or she would probably start popping open the Pepcid.
Plan sponsors have fiduciary duties to both shareholders & beneficiaries but don't have access to underlying fee schedules & contracts with providers. Conducting regular audits of your plan expenses is the only way to look under the hood at your third party administrator and know whether claim payments are accurate.
During the presentation from ProClaim Medical Recovery you will learn about the various types of audit methodologies plan sponsors might use; learn about the contractual language your administrative services agreements should and should not contain regarding audits; learn what to look for and what to expect when hiring an audit firm; learn about the types of errors ProClaim auditors routinely find when auditing claim payments at TPAs..
Since 2005 ProClaim Medical Recovery has worked sponsors of self-insured group health plans and during the last seven years our analysts have identified and recovered millions of dollars of overpayments for our clients. We have worked for private sector employers, multiple employer welfare arrangements ("MEWAs"), county and city governments, and associations. We provide a truly independent set of experienced eyes to analyze claim payments, identify and recover overpayments.
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