RANDOM SAMPLE CLAIM AUDITS

Random Sample Claim Audits provide plan sponsors with an accurate gauge of claims payment accuracy. Using a stratified random sample of audit claims, we identify overpaid claims, underpaid claims, claims paid for services not covered, and claims that should not have been paid at all. The audit sample is assembled to be a statistical reflection of all claims paid during the audit period, so the audit results give you a very good idea of what is happening with your claims payments across the entire plan.

The plan administrator is a part of the audit process and is given an opportunity to review and respond to all identified payment errors. Therefore, our client gets an audit report that contains both audit results as well as input and responses from the plan administrator.

The number of claims included in the audit sample varies by plan size. However, many plan administrators limit the number of claims that can be audited to about 250.

Random Sample Claim Audits are conducted on a base fee plus a travel reimbursement.