Internal Auditors have become the focal point for many claim recovery and enrollment audits of group health plans across the country. Historically, internal audit departments limited their reviews of group benefits to simple invoice reconciliations. However, with health costs one of the largest and fastest growing non-payroll expenses, the question being asked by many internal auditors is "what if the invoices themselves are wrong or have excess costs?". New Sarbanes-Oxley requirments make this a most pertinent question since errors in health plans can mean major financial losses that can have a material impact on a company's finances.
Everyone knows there is waste and abuse in health care expenses. Internal auditors see it as their job to determine how much of that waste and abuse effects their company's health plans. Advance data mining techniques and software support tools offered by Health Decisions help answer this question -- with less time and effort than traditional sample audits or invoice reconciliations.
Health Decisions facilitates communications between internal audit departments and human resource or benefits staff. Each has the company's best interests in mind but each have their own vocabulary, priorities, and points of view. By providing a common set of facts, accessible to all parties Health Decisions can help make the discussion about claim recovery and enrollment audit results more productive and less stressful.
Health Decisions service also helps define follow-up options and establish an agreed to agenda for pursuing claim recovery or addressing enrollment communication gaps.
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