Over the past two decades, medical claim auditors have made substantial advances, primarily driven by technological advancements. Enhanced systems and software have revolutionized an industry that once relied on random sampling, allowing auditors to now conduct thorough checks on every claim paid. The significant shift has increased the thoroughness and value of auditing processes, especially...

Are you managing a self-funded corporate or institutional employee medical plan? If so, you're likely familiar with the challenge of delivering excellent services to your plan members while controlling costs. Each claim processed must be precise and align with the coverage parameters. Medical claim audits are valuable partners in overseeing and managing your third-party administrator (TPA)....