Claim Recovery and Overpayment Audits

Claim Recovery and Routine Plan Monitoring

Health Decisions’ Comprehensive Medical Claims Audit service uses innovative technology and Expert Review to identify claims that are the responsibility of another party. As the market leader in healthcare claim recovery audits, we help self-funded employers optimize the performance of their health plans through healthcare cost containment. The audits are comprehensive and screen 100% of paid claims in more than 40 audit categories including provider payments, coordination of benefits, and cost-sharing.

Our Routine Plan Monitoring (RPM) service monitors plan improvements and maximizes recovery. Plan-endorsed service standards (over 50 metrics) are defined and monitored monthly. Claim payment errors are flagged for quick resolution. Quarterly overpayment audits monitor claim recoveries and avoid filing limits. Year-round reporting confirms what is working well.

Having conducted medical claim audits and administrative overpayment audits since 1989, Health Decisions is one of the most experienced health claim audit firms in the nation. We exceed the industry standard in a number of different ways:

  • Leader in sophistication of query logic and case detection software;
  • Data in any format accepted;
  • 100% of claims reviewed – no sampling;
  • Expertly manage collections phase to provide health benefits savings and a solid ROI;
  • Follow through on healthcare claim recovery findings to ensure future savings; and
  • Respect for existing procedures – you reduce health care costs without changing coverage.

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409 Plymouth Road, Suite 220 • Plymouth, Michigan 48170
phone 734­.451.2230 • fax 734­.451.2835
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