Self-Funded Insurance Plan Audits

man looking at data charts on table

Think Beyond the Bottom Line.

MCM is one of the only top-100 accounting firms with the expertise to perform claims accuracy and performance audits. Our national practice has successfully performed more than 300 medical, life, disability, dental, vision, FSA, pharmacy, and workers’ compensation claim audits. Our accounting professionals also bring their unique background to the process, evaluating not only the present issues, but also the claims payment and process controls.

When is a claims audit right for me?

We recommend all self-funded plans with more than 250 covered lives consider a claims audit if any of the following are needed or present:

TPA validation

Validate your TPA’s performance to contractual and industry standards

 

Healthcare spending identification

Identify and mitigate unnecessary healthcare spending.

 

Process verification

Verify your processing accuracy for performance guarantees with your TPA.

 

TPA transition

Transition to a new TPA or make significant changes to the benefits. Supplement your processes by adding additional scrutiny of these significant costs.

 

Monitor your fiduciary responsibilities

If you want increased governance and monitoring of your fiduciary responsibilities, call us.

 

National expertise

Gain access to national expertise without incurring the costs of employment.

Let's dig in and get to work.

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