Health plan audits that review every claim paid offer some of the most reliable data to health plan managers. While audits began as a compliance measure, they have evolved into essential management and cost-containment tools. Regular medical claim and PBM auditing services, and in some cases continuous monitoring, is beneficial for self-funded plans operated by…

As the costs of medical services and prescription drugs keep rising, employee benefit plans experience mounting pressure to stay financially healthy. Comprehensive audits act as essential tools toward maintaining oversight. Today’s medical claim and pharmacy benefit manager audits must review an ever-broader array of covered services, medications, negotiated pricing systems, maximum allowable charges, and rebates.…