Health care costs consume an ever-increasing part of the economy, and employers self-funding their benefit plans bear much of the burden. Sponsors can better understand the cost increases by scheduling a prescription claims audit. Most outsource their claim administration and receive reports from processors. But auditors add a layer of oversight and additional reporting that adds valuable...

The coronavirus pandemic turned things upside down financially for many health plans, with increased utilization and astronomical costs for some treatments. In its wake, medical claims audits are one of the ways plans have conducted post-mortems on their experience. The impact of a once-in-a-century event can't be overstated, and where there were mistakes and overcharges, the opportunities for...

Large employer-sponsored health plans for years have used medical claim audits to evaluate their plan's performance and that of their third-party administrators. Therefore, payers receive the most attention for their claim audits, but providers can also benefit. Some try to handle it in-house, but an increasing number are working with claim auditors to review their billing. Errors in coding or...