CFO / Benefit Manager
CTI leads the way in independent, self-funded claim audits. By using our custom audit approach and proprietary cutting-edge technology, we help our clients reduce claims expense while improving service to their employees. Unlike our competition, we go beyond the traditional audit, enabling our clients to see the problem, fix the problem and prevent it from happening again.
Nowhere else in the health insurance industry will you find an audit approach as thorough and vigorous as CTI’s approach to healthcare audits. Our innovative, proprietary technology and systems provide you with the information needed to measure and improve the claim administration of your self-funded plan.
By combining our audit and continuous quality improvement efforts, you’ll see that no one in the industry can provide an ROI quite like CTI.
When you choose a CTI audit your organization
will be able to:
- Compare your administrator’s performance quality to the best-in-practice
- Identify your most significant leaks and recovery opportunities
- Pinpoint the causes of the problems identified
- Prioritize your administrator’s attention on what they need to do to enhance performance
- Verify the ongoing results of the remedial actions taken
- Assure compliance with both federal and plan fiduciary requirements
A CTI audit provides an independent, accurate, and clear picture of administrator performance and identifies any needed improvements. We offer the following audit services:
Comprehensive Audit Analysis
Combines an 100% electronic review with a random sample audit to identify opportunities for overpayment recovery, validate performance guarantees and compare administrator performance against industry standards for development of quality improvement plans for:
Electronically audit 100% of your pharmacy claims to ensure they are being paid correctly. If problems exist, we identify them and address the steps needed to fix the problem.
- Pricing and Discount Guarantees
- Benefit and Plan Design
- Fraud, Waste and Abuse
- Retiree Drug Subsidy (RDS) Year-End Reconciliation
- Employer Group Waiver Plan (EGWP) Prescription Drug Event
- Formulary Guidance and Recommendations
Flexible Spending Account (FSA)
Assure your plan is being accurately administered in accordance with your plan specifications, government guidelines, IRS regulations and is compliant with contribution limits.
Determine if your administrator’s systems and the claims they have paid are in-line with your plan. If problems exist, we identify them and address the steps needed to correct them going forward.
Line-by-line electronic review of all underlying claims to uncover any issues to identify potential for duplicate claims, unbundling services, third party liability, excess usual and customary, and other edits.
We perform data analytics as a routine part of a comprehensive audit. Our expert auditors and programmers are able to help you with any data mining insight you are seeking.
100% of claims paid in the audit period are independently verified for eligibility of insureds by cross-matching the plan sponsor’s eligibility data with the administrator’s system eligibility data. The report provides a listing of payments made to ineligible insureds along with an analysis of procedural weaknesses.
Expert Witness Testimony
Claim Technologies Incorporated leads the way in legal assistance and expert witness testimony for the group health insurance industry. We offer in-depth knowledge, years of experience, and the subject matter expertise needed to help our clients win more cases. We have deep roots in claim adjudication, self-funded health plans, billing, provider discounts and so much more. Contact us for our affordable hourly rates today.