Insights that make a difference

Medical and pharmacy claim audits can typically find errors among 2 to 5 percent of total claims, which can represent significant dollars for self-funded plan sponsors. Comprehensive independent claim audits not only confirm claims are correctly processed, they can also aid in the recovery of over payments, evaluate quality assurance and monitor a third party administrator’s (TPAs) performance. While health claims audits can be conducted at any time, these four circumstances may indicate your plan is due for a check-in.