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 firms have quickly leveraged these technological possibilities, equipping themselves with unmatched expertise to help self-funded plans perform critical oversight of their outside claim administrators. 

The consistent and meaningful improvements brought about by better technology have transformed claim audits in numerous ways, most notably through implementing 100 percent reviews and reducing human involvement in the auditing process. The ability to check every claim represents a shift from traditional random sampling methods. It leads to more comprehensive assessments and identifying individual errors. Moreover, the reduced human involvement allows for more factors to be double-checked with no additional cost added, resulting in improvements over the original methods. 

Due to the efficiency of today's electronic claim reviews, many large employers sponsoring health and pharmacy plans have adopted continuous monitoring. It has enabled the timely generation of monthly reports, allowing for errors to be identified and emerging trends in their infancy to be recognized. As a result, plan management and the anticipation of cost increases have become more accessible and clearer with factual data. The ability to make year-to-year and month-to-month comparisons has provided valuable insights, and auditors can promptly pass along any questions that arise. 

Claim auditing firms that combine advanced software with knowledge of best practices for claim administration are significantly advantaged. Their ability to provide a more thorough and accurate audit results is actionable information for plan managers. Furthermore, an independent study of the statistics reported by third-party administrators is always wise, as utilizing different software for the review can reveal additional insights. This comprehensive approach goes beyond what generalist firms can provide, demonstrating the transformative impact of technological advancements in the field of claim auditing.