A healthcare plan audit program
to safeguard your plan assets
is a Best Practice

top_right_focused_sampleOperational Reviews

Periodic Operational Audits of your Third Party Administrator are an integral part of a well-rounded audit program. A well-designed and executed Operational Audit accomplishes the following for the self-insured employer:

        • It enables the client to better understand how the plan administrator functions and how efficiently the client’s claims are being processed.
It determines if the plan administrator is operating within industry standards.
It identifies opportunities to improve plan effectiveness.


A MedReview Operational Audit focuses on the policies, procedures and practices the plan administrator uses to pay the plan sponsor’s claims.


All Operational Audits address the following processes:

•Eligibility Data Maintenance
•Coordination of Benefits
•Application of Plan Benefits
•Processing of Facility Claims
•Processing of Professional Claims
•Timeliness of Payment
•Internal Auditing/Quality Control


An Operational Audit may confirm that your plan administrator is performing well or we may discover that there are issues that need to be addressed.