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. If warranted, MedReview will recover any overpayments on your behalf.
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 over the past eighteen months. Utilizing our proprietary software, we assemble an audit sample of approximately 250 claims from the file, due to time constraints, most TPAs will not permit on site audits of more than 250 claims. 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.