Beyond Dawlish

Today, technological advances have significantly impacted various industries, and claim auditing is no exception. Healthcare auditing companies now benefit from advanced systems that can meticulously examine paid claims with a level of detail never before possible. It has led to a marked improvement in audit accuracy and enabled today’s impressively detailed electronic reports. Specialist audit ...

When evaluating potential medical claim auditors for your company's health and pharmacy benefit plan, inquire about their technological capabilities. Many specialized firms utilize advanced, proprietary software that gives them a competitive advantage. Their systems are designed to efficiently and cost-effectively review 100% of your plan's claim payments, meticulously checking each for hundreds ...

Employers sponsor and self-fund health and benefit plans for various reasons, including financial considerations. The costs of these plans can be substantial and vary widely due to external factors, making oversight such as reviewing claim payments in a medical and Rx audit essential. It's the most effective method of scrutinizing expenditures and ensuring that claim payments adhere to the ...

Watching payments continuously is one of the newest trends in medical claim audits . It allows plan sponsors (large corporate and nonprofit employers self-funding their benefit plans) to keep closer tabs on their cash outflow. Benefit claim administration established a scenario where one company can access another organization's checkbook. It creates one of the most clearcut needs for oversight ...

When administrators pay thousands of claims daily, even the most accurate ones will make errors. Scheduling and running a healthcare audit routinely makes sense and helps double-check their work. Today’s best claim auditors are more like management consultants who analyze plan performance and suggest improvements – along with the standard work of flagging errors. Medical billing is necessarily ...

Employer-funded health plans have made news twice recently in the legal arena. Some sponsors have taken their claim administrators to court, and class action lawsuits on behalf of members are planned. In each case, a healthcare audit may figure into the causes for action of defense against them. An independent review of claim administration and payments is essential to confirming reports from ...

Nothing produces factual data about a health plan's performance more accurately than a claim payment review. The valuable data explains why medical claims auditing continues to grow in importance as employer-funded health plans struggle to contain costs. When today's advanced systems electronically review a plan's claim payments, the reports produced give unmatched insight into all ...

Every year, the news gets better about the accuracy and performance of healthcare auditing companies . Their proprietary software can quickly review 100 percent of claims for any employer-funded medical or pharmacy benefit plan. With budgets under pressure at corporate and nonprofit employers alike and medical costs skyrocketing unendingly, ensuring accurate payments is essential. Many claims ...

The trend for many years has been for large employer-sponsored health plans to outsource their claim administration. It achieves economies of scale, and the broader agreement allows members to enjoy the provider network of a major carrier. But there's always the need for oversight, and that's where a medical insurance audit adds value. Running one can confirm the correct things and flag the ...

The never-ending drive to improve technology is now getting so far with artificial intelligence that it's causing alarm. But advances in other areas, like claim reviews for a healthcare audit , benefit significantly from advanced technology. Reviewing medical and pharmacy claims has become a big business as large employers who self-fund their plans seek help. With third-party administrators ...

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