Medical and prescription plans need to pay their claims accurately for cost containment and good member service practices. Managing budgets is a priority for most large employers that sponsor employee benefit plans and self-fund them. Claim auditors can give a snapshot of a plan's performance for any period and report on cost-saving opportunities. Everyone benefits when claims are paid correctly. Each one has dozens of details, and the third-party processors make errors; it affects both sponsor and plan members. Finding and repairing systemic errors can add up to big money in the short and long term.

Auditors specializing in claims spend years perfecting their electronic reviews and honing their methods. Today, you can find unprecedented speed and accuracy as they automatically review millions of data points. Even since the beginning of 100-percent audits in the 1990s (previously, it was a less reliable random sample method), things have only become better. Claim audits moved from being a compliance necessity to a valued management tool. As expectations increase, they're helped keep claim processors on track with fewer errors. Audits soon after the fact make recoveries easier.

One of the more recent advances is a continuous monitoring service. It means auditors never stop reviewing a plan's claim payments. As they check processing continuously, every irregularity is flagged in real-time and can be recovered if it is an overpayment. C-suite executives reporting earnings and concerned with shareholders are fans of better accountability with all cost centers, including medical and other benefit claim payments. When there are increases or new trends, being able to explain them in real-time is helpful. Nothing is worse than reporting claim cost increases with an insufficient explanation.

Consistent oversight and auditing are required in any financial transaction, and medical claims are no exception. Keeping tabs is crucial with most processing today outsourced to third-party administrators and pharmacy benefit managers. TPAs and PBMs may guarantee their performance, but only a health plan auditing services can confirm it. Without a periodic review, sponsors have little backup to assure processing is as accurate as possible. When new treatments and medicines come on line, they need to be integrated into existing systems so that they function smoothly and efficiently always,