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Industries > Employee Benefit Funds  [+]  Associations and Not-for-Profits  [+]  Business Enterprises  [-]  Employee Benefit Funds       [+] Brochure (PDF)       [+] C-Bulletin Alerts (PDF)       [-] Claims Audit       [+] C-Bulletin Newsletter (PDF)       [+] Payroll (Employer) Compliance  [+]  Labor Organizations Related Industry Links  [+] AICPA Employee Benefit Plan Quality Center (EBPAQC)  [+] American Institute of Certified Public Accountants (AICPA)  [+] Department of Labor (DOL) Employee Benefit Security Administration      [+]   ERISA Reporting Forms (5500)  [+] Employee Benefit Research Institute (EBRI)  [+] International Foundation of Employee Benefit Plan (IFEBP)  [+] National Coordinating Committee for Multiemployer Pans (NCCMP)  [+] Pension Benefit Guaranty Corporation (PBGC)                                             Print this page     Email this page      Claims Audit Services Unlike many of our peers in the accounting industry, our employees spend a significant amount of their time servicing our clients and their related benefit plans, providing us with the opportunity to develop claims audit services. In fact, our claims audit services are in demand because: Medical inflation is rampant and mismanagement of claims dollars is widespread in the industry. Due to rising health care costs and an inflationary economy, claims dollars are getting larger with no end in sight. More complicated and complex medical plans and benefit packages aggravate claims processing systems. Medical billing errors and overcharges are nearly commonplace in every plan or system. Plans at risk need to reduce exposure. How Can Calibre CPA Group Help Me? Partnering with Calibre CPA Group allows our clients to make health benefits decisions with confidence: We will point out overpayments, underpayments, miscalculations, and other problems that result from errors in processing. We can measure performance and assist with developing a plan for improvement. You will be able to proactively manage medical benefit expenses and save money. You will be able to make an informed decision about probably one of your largest resource expenditures - employee benefits claims. What Are Your Claims Audit Services? Our procedures typically include the following: Use of general computer audit programs to randomly select the claims records to audit. Verification of claimant and, as applicable, dependent eligibility. Calculation of claim payments to determine compliance with the Fund’s plan of benefits, including the following (where applicable): Arithmetic accuracy Comparison to usual and customary guidelines Correct application of deductibles Correct application of co-payments Annual out-of-pocket maximums Benefit limitations Documentation on file Preferred provider organization (PPO) discounts Review processing of claim payments, including the following (where applicable): Coding accuracy Assignment of benefits Completed claim forms Coordination of benefits Subrogation Preexisting conditions Completeness of documentation Computation of average turnaround time. Want to Know More? To learn more about what we can do for your organization, please contact us or call 1.866.464.2839 Back to top Contact us at info@calibrecpa.com or call 1.866.464.2839       Contact Us

1850 K Street NW, Suite 1050, Washington, DC 20006 • 202.331.9880 phone • 202.331.9890 fax Civic Opera Building, 20 North Wacker Drive, Suite 900, Chicago, IL 60606 • 312.920.9400 phone • 312.920.9494 fax © Calibre CPA Group