Medical plan audits and consulting, Claim Technologies Incorporated provides claim administration audit, including medical claim audit, medical claim review, and medical plan claim audits

CTI's audit and control approach is designed specifically to help self-funded health plan sponsors address the control risk and quality of service concerns inherent in third party claims administration. 

Use of CTI's approach makes it possible not only to identify (and in some cases recover) costly errors, but also to improve claims administration processes. The former is of particular importance in assuring timely intervention on problems that would otherwise go undetected. The latter is where the greatest benefits can be realized over time due to the dramatic leverage that improving key administrative processes has on reducing claims expense and improving service.

Audit Goals and Benefits

CTI's audit "mission" is to empower Benefits Managers with accurate, easy-to-understand, and independent accountability and control information they can use in collaboration with their claims administrators to reduce claims expense and improve service to their plan participants.

Medical Plan Audits

Comprehensive Audits, Basic Audits, and Due Diligence & Recovery Audits comprise the majority of our practice, but we specialize in custom applications as well. Our approach is based on four major components as enumerated in the following table. While all four components typically are proposed, different alternatives and degrees of rigor are available depending on plan size and complexity.

What's "Different and Better" About Our Approach

Unique to CTI's audit and control approach is the way in which it links both electronic screening and statistical sampling with the techniques of statistical process control. In addition to performance measurements based on industry standards (and others of our own), we provide insights as to the quality of the administrative processes and what can be done to improve them. Whereas the audit "report card" marks the end of conventional approaches, with our approach a statistically supported, prioritized plan of corrective action also is provided that effectively marks the beginning of the quality improvement process.

CTI AUDIT AND CONTINUOUS QUALITY IMPROVEMENT CYCLE

As illustrated by the above chart, and as borne out by our experience over the past 20 years, effective audit and control of claims administration is a continuous process in and of itself. Depending on client needs, our audits will include up to five phases:  Data collection, data analysis, problem prioritization, action planning and continuous process monitoring.

While the first four phases of our initial audit will meet near-term client objectives, it is through the fifth phase (Continuous Process Monitoring) that control risk reductions, performance improvements, and savings can best be realized over time. Although optional, "keeping the gate" with these services has proven highly beneficial to the CTI clients who do so.

Optimum Results / Maximum R.O.I.

Attributing tangible benefits to conventional claims audits is difficult in most instances and the effectiveness of follow-up activities is rarely substantiated. Our approach, on the other hand, provides specific, easy-to-understand management data as to the savings and service improvements to be addressed as well as the results of doing so. Conventional audit approaches simply cannot match the return on investment achievable with CTI's.