BMI joins the Kaleidoscope podcast to discuss how claims auditing helps employers reduce fraud, waste and abuse found in health care benefit plans.
KEY TAKEAWAYS:
Claims are becoming more complex and payment systems have become more sophisticated, but payment errors continue to happen.
There is a lack of transparency into claims' data. Administrators are prohibiting employers from looking at the details of paid claims and making it more difficult when allowed.
Brokers and employers need to do their due diligence during contract renewals and while moving to a new administrator. Thorough review of the Administrative Services Only (ASO) fine print is needed to identify and prevent any restrictions around audit rights.
There is a growing trend of brokers who understand the value of having an independent 3rd party audit plan set up. This ensures a client is set up for success and accurate benefits are being provided to plan members.