In an era of rising costs and unexpected events, employer-funded health plans can take several proactive measures, with a top priority being the review of claim payments. Using medical claim auditing services as an effective management tool is wise for numerous reasons, including oversight of third-party administrators, identifying inconsistencies, and ensuring claims are processed accurately and consistently. This approach offers significant financial and management advantages in the short and long term and helps pinpoint errors before they escalate into costly issues. 
Today, many specialist claim audit firms meticulously review 100 percent of claims, examining every detail. Their advanced software and methodologies allow for an in-depth evaluation of a claims administrator's procedures. The most impactful changes are often systemic improvements that help avert future mistakes. However, it's also common to identify specific issues that are recoverable, such as overpayments made in error. The outcome of an audit typically strengthens the plan, and the cost of the service is generally far less than the errors it uncovers, all accruing to best plan management practices. 
Modern claim audits produce clear and actionable reports, a significant improvement from the less detailed reporting of past random-sample audits. Thanks to technological advancements, auditors can now examine a more substantial number of claims with more data points in a shorter time frame and with less manual intervention, leading to greater accuracy. Medical claim auditing has truly been transformed by technology, and pharmacy claims should be audited with the same frequency, as they involve different criteria but are equally valuable. When combined, you can run a healthcare audit covering both.
While fulfilling fiduciary and regulatory obligations can motivate an audit, sound plan management practices hold even greater significance. The advantages of reviewing all medical claims are substantial, offering insights into emerging trends. Some employer-funded plans utilize continuous audit software to monitor payments in real-time. It allows monthly updates to alert internal teams to potential issues before claim administrators flag them, combining peace of mind with effective management strategies to help avoid unexpected expenses.