For most self-insured companies, claims costs in the group health plan represent a major operating expense. Yet, many firms do not have proper safeguards in place to make sure this money is being handled properly. Many claims are overpaid, and claims get paid for services not covered by the plan. Claims get paid for patients who are not eligible for plan coverage, and some claims get paid more than one time.

We help self-insured employers control their healthcare costs by providing a full range of audit services. Many of America's largest and most respected firms use our services. Each year, we conduct hundreds of medical claims audits and pharmacy audits with dozens of different ASO firms, TPA firms, and PBM firms.

Why should you audit your TPA or PBM firm? There are several reasons. First, it's your money, and you have a right to know it is being properly handled. And, as a plan sponsor, you have a fiduciary responsibility to manage claims costs and to make sure plan liabilities are being properly recorded. Also, a good audit program can help you better understand how the ASO firm, TPA firm, or PBM firm works and can help you negotiate better contracts going forward. In short, it is just good business practice to conduct regular audits.

We conduct audits for a wide variety of plan sponsors. They are from all economic sectors - manufacturing, transportation, finance, communications, etc. Some of our clients are also healthcare providers who self-insure their group health plans. We also conduct audits for non-profit organizations and governmental agencies. Some of our clients have as few as 500 employees enrolled on their group plans; others have as many as 50,000.

Contact us today. We are glad to conduct an initial consultation.