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A Health Plan Cost Containment Opportunity


For every health plan, the eternal challenge is managing the never-ending rise in costs. As a result, plan sponsors should remember the value of medical claim auditing services. With today's technology, they can double-check every claim paid for accuracy and compliance with a plan's provisions. It presents a significant cost containment opportunity because mistakes and overpayments add up, even when the percentage of claims is small. Years ago, recovering individual errors after a random sample audit would have been unthinkable. But today, it's a common practice as auditors check 100 percent of claims.


What's so great about auditing is the ability to provide oversight of outside claim administrators. With them paying medical and pharmacy claims thousands at a time, even the best ones can make errors. They also might miss medical providers' mistakes in coding on invoices and other technicalities. You'll be impressed with the thoroughness when you receive an auditor's report with every irregularity flagged. Electronic claim reviews on sophisticated software produce impressive results and can monitor claim payments in real-time. Imagine receiving monthly reports with factual data.


It's helpful for large employers that sponsor health and pharmacy benefit plans to use audit reports as part of the basis for budgeting. The more that's understood about claim payments and administering them accurately, the more on target the budgets become. Auditing frequently also helps identify emerging trends so they can be well understood before they become significant. When costs and utilization skyrocketed during the coronavirus pandemic, reviewing every claim was even more valuable. Audit reports can be compared with claim administrators' ones to clarify expenses.


There are several advantages when auditors develop a long-term relationship with a health plan and audit it routinely. They include comparing current and past periods and learning more about claim payments with each audit. Over time, it's possible to track thousands of details that add to significant trends and expenses. The findings from claim audits are also helpful for planning and ensuring all members are treated equally – and fairly. Providers that make errors in billing can bring thousands in unnecessary costs. When auditors flag their mistakes, correcting them and preventing more is possible.


Company Name- TFG Partners, LLC


Address- 437 Grant St #1020, Pittsburgh, PA 15219


Contact Number- (412)-281-2228

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