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Outsourced Accounting Solutions
Payroll (Employer) Compliance
Tax Preparation and Planning
Related Industry Links
AICPA Employee Benefit Plan Quality Center (EBPAQC)
American Institute of Certified Public Accountants (AICPA)
Greater Washington Society of CPAs (GWSCPA)
Illinois CPA Society (ICPAS)
International Foundation of Employee Benefit Plan (IFEBP)
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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):
Comparison to usual and customary guidelines
Correct application of deductibles
Correct application of co-payments
Annual out-of-pocket maximums
Documentation on file
Preferred provider organization (PPO) discounts
Review processing of claim payments, including the following (where applicable):
Assignment of benefits
Completed claim forms
Coordination of benefits
Completeness of documentation
Computation of average turnaround time.
Want to Know More?
To learn more about what we can do for your organization, please
or call 1.866.464.2839
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Contact us at
or call 1.866.464.2839
7501 Wisconsin Avenue, Suite 1200 West, Bethesda, MD 20814 • 202.331.9880 phone • 202.331.9890 fax
566 West Lake Street, Suite 300, Chicago, IL 60661 • 312.920.9400 phone • 312.920.9494 fax
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