Claims + Eligibility Audits
What you don’t know can hurt you. Often times it is not what a consultant does wrong that creates a costly issue for employers but what they fail to do. We are proactive and thorough in our recommendations when it comes to your full spectrum benefit planning needs.
Medical billing is complex and written in code. This can add up to a major drain for your health plan and on your employees’ finances. According to the New York Times, up to 90% of facility charges contain errors. If your hospital bill was incorrect, would you be able to spot the error? Regular claims audits are a way we proactively address this concern.
Eligibility can also be an area of vulnerability to the health plan. An audit to verify that those enrolled on the plan should indeed be covered is essential to limiting plan exposure and eliminating the risk of an unforeseen reinsurance denial for a member who has hit their stoploss deductible.