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.