Healthcare Audits

Our comprehensive audit approach and continuous quality improvement efforts have made us a leader in healthcare audits. Our innovative technology and proprietary systems help to confirm that the claim administration of your self-funded benefit plan is meeting contractual obligations, creating peace of mind for you.

When you choose a CTI audit your organization
will receive:

  • An audit that uses best-in-practice methodologies and tools to complete your audit accurately and completely
  • Identification of any findings and recovery opportunities
  • Causes of the problems identified
  • Recommendations for remediation
  • Full audit report with result details

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Audit Services

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:

  • Medical
  • Dental
  • Vision


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
  • Rebate
  • 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.

  • Specific
  • Aggregate

Data Analysis

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.

Eligibility Verification

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 is one of the leading figures 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.


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