
Operational Reviews
examine the processes, procedures and systems that
your Third Party Administrator ("TPA") utilizes to pay your medical claims.
The following is a partial list of the areas our Operational Reviews examine:
MedReview's Operational Reviews focus on any specific concerns you may have. For example, we will review in detail the process used by your TPA to update employee and dependent eligibility.
Operational Reviews are fixed fee audits. The amount of the fee is based upon the number of employees in your plan.
Conducting an Operational Review enables you to grade the performance of your TPA and to work with your TPA to correct any problems that exist.
An
Operational Review may be combined with any of MedReview's
other medical claim audits. For example, combining an Operational Review
with a Focused Sample Claim Audit enables the plan sponsor to recover
all or part of the Operational Review fixed fee due to the overpayments
we recover as a result of the Focused Sample Claim Audit.