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- Most health care claims administrators limit the number of claims samples that can be reviewed on site to 300 or less.
- Making quality sample selections for on-site audit is critical to the success of the audit.
- Many insurers and administrators discourage or even prohibit audits where the auditor’s fees are contingent upon error recoveries.
- A cooperative effort between the client, auditor, and administrator maximizes the client’s ultimate “return on investment”.
- Systemic errors are difficult to detect when audit samples are selected randomly.
- Finding and correcting errant trends can result in immeasurable ongoing health care cost savings.
- Not all claims audits are performed objectively.
- We believe that audits should be conducted by an independent auditor with no revenue bias.
- As a sponsor of a self-funded health care plan, you may have a fiduciary responsibility to plan participants.
- Many plan sponsors protect health care benefit assets by engaging a reputable, qualified claims auditor to reinforce their fiduciary obligations and/or their Sarbanes-Oxley compliance programs.
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