Many large employers with self-funded medical plans were driven to conduct audits primarily due to government regulations like ERISA and Sarbanes-Oxley. However, today, a 100-percent medical or Rx audit will cover every claim processed and paid. As a result, the data generated has more use than merely regulatory compliance. It's becoming standard practice—and a smart management...

In addition to the significant financial benefits, an effective medical and RX audit to review paid claims is pivotal in enhancing member service and driving substantial cost savings for benefit plan sponsors. By conducting regular audits and identifying overpayments, claim payment irregularities, and error patterns, companies can recover past overpayments and prevent future errors,...