Random Sample Claim Audits
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.
This is a fixed fee audit. The amount of your fee will be based upon the number of employees in your plan, the number of TPAs you utilize, the number of networks you utilize and the number of plans you have.
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. This 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. Due to time constraints, most TPAs will not permit on site audits of more than 250 claims.
The audit identifies both overpaid and underpaid claims and provides you with an objective measurement of claims payment accuracy.
