Your Healthcare Focus

Event Audit

If you’re changing claims administrators or making adjustments to your plan designs, it’s critical to test the accuracy and readiness of your claims administrator before your go-live date.

Pre-Implementation Audit
To ensure your administrator is ready to process your benefits, we take a number of critical pre-implementation steps, including:

  • Testing your administrator’s interpretation of your benefits against your Summary Plan Description provisions
  • Providing an action plan and timeline for resolving any issues
  • Serving as the liaison between you and your administrator to clarify plan design discrepancies and direct corrections, as needed


Post-Implementation Audit
As beneficial as pre-implementation audits can be, they do have limitations. They are performed in a claims-system test environment and the scope of what is reviewed is restricted by the number and thoroughness of the scenarios presented. That’s why we often recommend that a 100-percent, post-implementation audit be performed 90 days following the effective date of a material change. Our experience has found this to be an even more rigorous and complete approach to testing benefits interpretation and setup.

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Watch a Video

Two Minutes to Claims Auditing
Marie Bowker, Senior Director of Practice Leadership

Two Minutes to Payment Integrity
Jean MacQuarrie, Vice President, Payment Integrity Solutions