How can USI help our organization gain better control of our medical claim costs?
USI recommends periodic medical claims audits to eliminate wasteful and inappropriate charges from providers, administrators, or members.
USI assists clients with selecting appropriate vendors and determining the scope of the audit.
We’ve estimated the financial impact for you. Feel free to update the assumptions.
- Helps ensure accurate claims processing and appropriate reimbursement to both providers and plan members
- Ensures compliance with federal and state laws applicable to claim type
- Provides leverage to negotiate service guarantees (up to 20% of plan administrative costs) and sets appropriate expectations with the plan administrator
The plan administrator will correct any system errors impacting claims processing and will initate recovery for incorrect reimbursements.
All self-funded plan designs should be periodically audited to ensure that the claims are processed accurately. In addition to medical claims audits, an organization can also seek a dependent eligiblibility audit to ensure that all plan members meet membership guidelines, as well as a post-implementation audit when a plan is setup with a new third-party administrator.
Claims audit costs are dependent on the size of the organization and the scope of the audit, but can range from $5,000 for a random claims file audit to $30,000 for a full-scale on-site audit.
I’d like to explore further how a medical claims audit can help our organization.
As part of USI's standard offering, USI service teams continually monitor our clients' claims reports and will suggest an audit if and when necessary.