• How to Run a Highly Effective Claim Audit
    Organizations that manage medical and pharmacy claim processing for self-funded employer plans must undergo regular audits. These reviews, run by medical claim auditing firms, are essential for regulatory compliance and financial oversight. The importance of medical claims auditing is particularly pronounced for larger plans. While audit firms can work with any claim processing system, creating...
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  • Medical Providers Benefit from Claim Audits
    Much of the focus on medical claim auditing services tends to be on plans provided by large employers. These employers self-fund their medical and pharmacy benefits, and with claims administration handled by third-party processors, ensuring accuracy is crucial. However, it's important to remember that physicians and their practices can also benefit from auditing claims. It helps them identify...
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