Health Insurance Daily

Preventing Overpayments In Health Claims

Knowing that health insurers sometimes make mistakes in processing and paying claims, experts advise employers to audit their health plans every two or three years.

About 24% of vendors incorrectly processed 5% or more of health claims last year, down from 35% in 2004, according to The Segal Co. Furthermore, 46% of vendors incorrectly paid 1% or more of claims dollars last year, down from 56% in 2004.

Anthony Rienzi, a senior vice president at The Segal Co., attributes those improvements to health plan audits. "Things have improved fairly substantially. Auditing does improve results over time," he told attendees at the Benefits New York conference yesterday.

As an object lesson for employers, Rienzi recalled finding $700,000 in overpayments in a sample of 225 claims. Insurers aren't perfect and won't promise perfection, he said, but it's important to hold them accountable for factors over which they have direct influence, such as the timing of payments. Watch out for eligibility problems, such as incorrect hiring dates and termination dates, payments to ineligible dependents, and improper plan classification, he warned.

Article provided by BenefitNews - March 14, 2006

posted by Mike @ 8:25 AM