Author: tfgpartners

Managing health and pharmacy benefit claims is complex, and accuracy is crucial, given the expenses involved. As medical claims auditing has evolved, it offers sophisticated methods that allow for thorough claims reviews at a granular level. It helps plan sponsors, and their auditing firms identify numerous variables for evaluation, enabling them to answer more questions regarding claim costs with factual accuracy while analyzing and comparing results against other factors. The advancement provides plan sponsors with an exceptional ability to monitor claim processors effectively. The rapid introduction of new tests and treatments amid a chaotic emergency during the COVID-19 pandemic underscored the importance…

The surging costs of medical care and medicines and the recent coronavirus pandemic have placed unprecedented financial strains on self-funded health plans. In response, healthcare audit firms are stepping in to assist. One effective approach is their continuous monitoring service, which scrutinizes every processed claim. This ensures that in-house plan managers can verify the accuracy of claims administration and adherence to established guidelines. During periods of high demand and with new challenges like COVID-19, the likelihood of errors and overpayments can skyrocket. It is crucial to catch and report these mistakes in real-time. Monitoring expenses related to COVID-19 testing and…