A MedReview Random Sample Medical Claim Audit will provide you
with an objective measurement of the claims payment accuracy of your Third
Party Administrator (“TPA”) and reduce your benefit plan’s operating expenses.
The Random Sample Audit identifies both overpaid and underpaid claims and is based upon a stratified random sample of claims paid during the audit period. Claims of all types and dollar amounts are included in the sample.
To begin the claims audit process, MedReview requests an electronic
claims file from your TPA. This file includes 100% of the claims
paid by the TPA on your behalf. Utilizing our audit specialists and proprietary software, we assemble an audit sample of claims from the file. This sample results in a statistical
representation of all claims paid during the audit period. These claims
are then subjected to an intense, in depth review on site at your TPA’s
claims paying office.
The Random Sample audit identifies both overpaid and underpaid claims and provides you with an objective measurement of claims payment accuracy.
The Random Sample Audit is supported by a general Operational Review.