Electronic Medical Claims Audits
An Electronic Claims Audit examines all claims incurred during the audit period. No sampling of claims is involved.
The client’s benefit plan schedule is loaded into our software, and each claim is examined for potential payment or processing errors. In addition, the Electronic Claims Audit includes extensive data analysis to help the plan sponsor understand the types of claims incurred, locations of incurred claims, and the effectiveness of the provider networks.
An audit period consists of either one or two complete plan years.
Electronic Claims Audits provide a definitive measurement of how effectively the plan is being administered.