Random Sample Claim Audits

reduce your benefit plan’s operating expenseS

A MedReview Random Sample Medical Claim Audit will provide you with an objective measurement of the claims payment accuracy of your Third Party Administrator (“TPA”) and reduce your benefit plan’s operating expenses.

The Random Sample Audit identifies both overpaid and underpaid claims and is based upon a stratified random sample of claims paid during the audit period. Claims of all types and dollar amounts are included in the sample.

After receiving an acceptable electronic claims extract, 100% of the claims are loaded into our proprietary software. MedReview will analyze its size and dollar composition in order to establish a sample size. When the sample has been established, a stratification analysis is performed. Claims are then selected by stratum.

In the final report, the results of the sample errors are extrapolated back to the full data population. For every finding that we feel is systemic in nature and could have an out of sample impact, we will check all related claims in the data set and report on the number of out of sample claims with potential errors as well as give a dollar amount of those errors.

Our final reports include recommendations to plan language to ensure that the plan’s intentions are being adhered to and are not being overridden by the Standard Operating procedures of the Administrator.

The Random Sample Audit is supported by a general Operational Review.

MedReview provides post audit support as requested by our client and until our client is satisfied.