Healthcare Claim Auditing

Healthcare Claim Auditing
Opportunity Analysis

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Providing actionable data so you can make the right decisions.

Our expertise in health claim adjudication and analysis gives you invaluable insight into precisely where your healthcare dollars are being spent. With this knowledge and information, opportunities for cost management and plan improvement are discovered. From there, our team engages with practical solutions and strategies to capitalize on those opportunities. An extensive review of multiple documents and claims include:

Document Review

• Summary Plan Document (SPD) review
• Administrative Services Agreement (ASA) review
• Pharmacy Benefit Management (PBM) contract review
• Stop-Loss Contract review
• Wrap Document review
• Section 125 Plan Document review
• Consolidated Appropriations Act audit/review

Claims/Utilization Review

• Targeted & Randomized Claim Audits
• Medical Claims
• Prescription Drug Claims (Generic/Brand/Specialty)
• Benchmarking
• Specific & Aggregate Stop-Loss Claims
• Reference-Based Pricing Analysis

Stop-Loss Analysis

• Specific Deductible analysis/Probability analysis
• Aggregate Attachment Point analysis
• Agg/Spec Probability
• Laser analysis
• Self-Funding Feasibility analysis