White Papers for Claims Audit Managment and Fiduciary Issues

AUDIT AND CONTROL OF HEALTH PLAN CLAIMS ADMINISTRATION – A BRIEF HISTORY WITH DISCUSSION OF AUDIT APPROACHES, OBJECTIVES, AND TECHNIQUES YIELDING HIGHER R.O.I. 

Since the advent of self-funding of health plans in the 1980’s, plan sponsors have come to recognize the significant and material control risk inherent in third party and in-house claims administration. As a result, today a substantial majority of plan sponsors regularly engage independent firms to audit their carriers or TPA’s. This CTI White Paper highlights Plan Fiduciary, trustee, and management issues providing background and insights as to audit approaches including the uses of statistical process controls to reduce claims expense
and improve service to plan participants.