Specific Claim Audits can be completed in our office, or on-site. A detailed, thorough review is completed for each claim. Claims are reviewed for adherence to the plan document and the excess loss agreement. We ensure that individual claimants meet eligibility requirements that benefits paid are valid and in accordance with the Group Benefits Plan, and that claims are properly adjudicated.
In addition to our staff of experienced medical claim professionals, we have access to, and may use, many other experts in the claims field. Our resources include RN’s, medical and legal experts, transplant specialists, large case managers, and hospital bill auditors.