Lovely Dimez Group

Not long ago, many self-funded medical plans conducted claim audits to meet regulatory requirements, often relying on random samples. If these medical claim auditing practices had remained unchanged during the pandemic, there would have been less scrutiny of claim payments, given the incredibly challenging year for many organizations. Fortunately, medical bill reviews have advanced, with many auditors now reviewing 100 percent of claims rather than relying on random selections. The shift has resulted in more accurate audits, which plans recognize as essential strategic management tools.

Audits that started to ensure compliance have evolved into a critical oversight mechanism that in-house plan managers now regard as indispensable. The advancement in auditing software has enabled these thorough 100 percent audits, which have led to asset recoveries that significantly outweigh the cost of the audits themselves. This process guarantees members receive fair treatment and strengthens the position of in-house staff in discussions with…

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