TPA Overpaid More Than $18K
Audit Issue
As standard process, claims data is scrutinized for possible duplicate payments. Comparison criteria include claims paid for same patient, same date of service, same procedure code, same charge, and same provider for different paid dates.
TPA Response
The administrator agreed that the claims processor overlooked an automated system edit and approved a duplicate payment more than seven months after its initial payment.
Audit Finding
Despite a sophisticated level of automated review for possible duplicate payments, errors of his nature are not uncommon.
Financial Error
The administrator agreed to a financial error of more than $18,000.00 for hospital outpatient charges submitted twice.
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