Nearly everything today is affected and often improved by technological advances, and claim auditing is no exception. Medical claim auditors today have vastly improved systems that can examine claims paid down to a minute level of detail. It improves audit accuracy over previous capabilities and means electronic reviews yield impressively detailed reports. Leveraging the possibilities is the work of specialist audit firms with unique abilities. They have unmatched expertise to help self-funded plans perform oversight of their outside administrators. The improvements are consistent and meaningful.
Among the ways better technology has transformed claim audits are 100 percent reviews (where every claim is checked) and less human involvement. It means more factors are double-checked with no additional tie of cost added. It's a revelation and makes vast improvements over the original random sampling methods. The only way to know about any factor is to check it on every claim paid. When it happens naturally as part of an electronic review, it's a win-win situation every time. Years ago, only repeating errors found in large groups were recoverable financially; now, they appear individually.
Given the efficiency of today's electronic claim reviews, many large employers sponsoring health and pharmacy plans monitor continuously. It's as simple as keeping audit software running in the background as claims are paid daily. It generates monthly reports that spot errors and identify trends in their infancy. Plan management and anticipating cost increases become more accessible and clearer with factual data. You can also make year-to-year and month-to-month comparisons which provide valuable insight. Anytime a question arises, auditors can run a check and give you an answer.
Claim auditing firms that combine more advanced software with knowledge of best practices for claim administration are at an advantage. They go beyond what generalist firms can provide, meaning a more thorough and accurate audit. Getting it correct with every detail seriously improves the value of a claim review and provides actionable information for overall management. If your third-party administrator is already reporting the data, having an independent study of the statistics is always wise. When an auditor runs a review using different software, it will pick up other things.
