When health plan sponsors initially outsourced their claim processing to third-party administrators (TPAs), oversight wasn't a top priority. However, the increasing accuracy of healthcare audit services has highlighted their value as management tools. While self-reporting by TPAs and pharmacy benefit managers is acceptable, it shouldn't be the sole method of monitoring plan performance....

The evolution and increased sophistication of medical claim auditing services has been driven by the increasing complexity of the healthcare landscape, including rising costs, medical treatment advancements, and the intricacies of medical billing. In response to these challenges, many large employers that self-fund their health plans have turned to medical claim audits to ensure oversight and...

The never-ending drive to improve technology is now getting so far with artificial intelligence that it's causing alarm. But advances in other areas, like claim reviews for a healthcare audit, benefit significantly from advanced technology. Reviewing medical and pharmacy claims has become a big business as large employers who self-fund their plans seek help. With third-party administrators...

The big money but generally quiet world of medical claim payments is suddenly making news as large self-funded plans are suing their claim administrators – which are well-known health insurers. It is expected to encourage more self-funded plans to run a healthcare audit to double-check their payments. Generally speaking, in business, it is a peculiar scenario when one company is hired to...