Overpayments can occur for a number of reasons including:
- Not properly coordinating payment with other responsible parties
- Paying the same claim multiple times
- Paying the provider more than their contracted rate
- Paying for benefits for someone who is no longer eligible for coverage
HMS’s Plan Audit services help identify these overpayments after they are made by your administrator. Our audit services also provide insight into what can be changed to prevent these
overpayments in the future.
Clients who have used HMS’s Plan Audit services (also known as Claim Audits) have been able to:
- Control wasteful spending by validating proper claim payments
- Ensure compliance with the law
- Reduce future claim payments
Plan audits help your organization take measures to ensure that claims are appropriately paid.
How Our Plan Audit Process Works:
- Information Gathering. We use the plan documents, enrollment data, and short questionnaire you supply to direct the course of the audit. Your administrator supplies us with the claims information.
- Data Interpretation and Audit. Our expert audit staff uses cutting-edge technology to interpret your data. We have analyzed over $10 billion in claims data from every national carrier.
- Sample Selection. We choose a claim sample that fits your organization’s objectives.
- Onsite Visit. Our experienced auditors visit your administrator’s office in order to examine the sample claims in their systems.
- Reporting and Recovery. We send a detailed report of the audit results to you and discuss recommendations on improving the plan’s compliance and performance.
Contact us today to talk about how we can help you control wasteful spending
Only HMS's single-door, program integrity solution offers a comprehensive approach to identify overpayments, increase recoveries, and prevent future overpayments.
