Claims Audit

Could cutting costs in one place lead to higher costs in another?

Finding solutions to rising healthcare expenses is a challenge every organization must face. The reality is, due to the numerous changes plan sponsors make to cut healthcare expenditures, they expose themselves to errors in benefits administration, leaving them vulnerable to claim overpayments and other errors in claim administration.

A comprehensive, objective claims audit will not only deliver peace of mind, it will give a measurable ROI. In fact, a claims audit can often pay for itself by averting overpayments on future claims. Further, a plan sponsor has a legal obligation to regularly and proactively monitor the performance of its claims administrator to verify its plan is being properly administered. For these reasons and others, a plan sponsor can’t afford not to conduct a claims audit.

AIM’s proven approach of exploring innovative employee benefit strategies while maintaining an eye on existing solutions is more important today than ever. AIM has the expert resources to perform in-depth claims audits of any size organization’s medical plan. A basic claims audit will pinpoint any errors and calculates the results. But, a more advanced audit will dig deeper to uncover the reasons behind the mistakes and make recommendations for ongoing error prevention and overall quality improvement.

Benefits of a claims audit conducted by AIM include:

  • Statistically valid medical plan claims auditing
  • Claim timeliness analysis
  • Operations assessments of the administrator’s claims processing and customer service capabilities
  • Comparison of claims administrator performance against industry standards
  • Validation of adherence to benefit plan provisions
  • Assistance in the return of incorrect claim payments
  • Detailed specific recommendations for improvement in claims processing
  • Want to learn more about how a claims audit is vital for plan administration and controlling costs?

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To read about specific cases where AIM has helped clients improve their benefits program and their bottom line, click on the links below.