Operational 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:
| •Training/Supervision •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.