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NiralPatel InjurLaw adicionou um novo artigo Outro
2022-05-30 11:01:12 - Traduzir -

Audits Drive Health Plan Quality Improvements
Medical claim audits started as a compliance requirement for most employer-funded health plans and were conducted by random sample. It satisfied regulators but provided little actionable data for in-house plan managers. Thankfully beginning in the 1990s and continuing to today, technology and methods have improved. It means that audits now review 100-percent of claims paid and check each one...

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TFG Partners adicionou um novo artigo Outro
2024-10-04 04:58:07 - Traduzir -

Putting the Pandemic's Lessons to Work
During the challenging times of the pandemic, employer-sponsored health insurance plans faced significant challenges and disruptions. It is paramount to frequently review claims in a medical and Rx audit to steer towards a more resilient and prosperous future. Despite the routine data reporting by claim administrators, it benefits employer-sponsored plans to schedule an external...

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TFG Partners adicionou um novo artigo Outro
2023-11-15 10:36:48 - Traduzir -

The Oversight Function for Claim Payments
Benefit plan claim payments, especially costly ones for health plans, need active oversight to watch for errors. Prescription and medical claims auditing is an excellent way to double-check payment accuracy and the work of claim administrators – third-party processors and pharmacy benefit managers. When large employers self-fund benefit programs and...

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