Beyond Dawlish

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 of data points. Given the intricate nature of medical and prescription plans, expertise and suitable systems are essential for accurate audits, creating a significant barrier for generalist audit firms to compete. 

Claim audits are essential for meeting compliance and fiduciary responsibilities and serve as oversight tools to ensure that third-party administrators and pharmacy benefit managers deliver as promised. While most firms offer accuracy guarantees, having an independent auditor verify claims is a wiser approach than relying solely on the firms' self-policing. The significant costs triggered by the coronavirus served as a reminder of the importance of meticulous plan management. The potential cost exposures for medical and pharmacy claims are substantial, underscoring the need to monitor spending trends. 

The advanced claims auditing service available today can monitor processing and payments in real-time continuously. This expanded service is the ultimate oversight tool and often results in significant savings that far exceed the service cost. Moreover, the generated reports give sponsors real-time control over their medical and pharmacy claim payments. When the processing function is outsourced, it can be challenging to keep tabs on activities. The independence of an audit ensures unbiased reports and a clear snapshot of payment activities, offering invaluable insights for effective decision-making. 

If your previous claim audits relied on the random sample method, it may be time to transition to a 100% auditing process utilizing advanced software. You'll be impressed by the minimal time commitment required once the set-up is completed. Frequent auditing or continuous monitoring has gained popularity in recent years and is particularly appealing to upper management accountable to boards or stockholders. Detailed reports about claim payments are essential for them, providing valuable transparency and accountability. Plan sponsors do better with claim payment oversight.