Managing employer-funded health plan claims is no small feat. Today’s third-party administrators (TPAs) and pharmacy benefit managers (PBMs) work with impressive accuracy. Still, TPA and PBM audits uncover mistakes or irregularities. With the volume of claims and the complicated nature of billing, it’s clear why regular claim reviews are so imp…[Read more]

In the early years of self-funded health and pharmacy benefit plans, auditing was primarily seen as a matter of regulatory compliance. However, that perspective has evolved significantly, mainly due to advancements in medical auditing technology. Nowadays, there’s even PBM RFP consulting, and the capability to scrutinize 100% of claims represents…[Read more]