3 Steps to Determine the Best Claim Audit Approach
If you are contemplating a claim audit project, below is a 3 step process to guide you toward making the best choice for your organization.
Step 1: Clearly understand your objectives. There are wide array of options available and the only method to figure out which is the best fit for your organization is first to understand what you want to achieve. Don’t gloss over this step. While one objective may immediately rise to the top, give consideration to other possible objectives that you may not have originally considered. Depending on the origination of the idea of conducting a claim audit, you may also want to incorporate the objectives of other departments, such as Internal Audit before continuing this process.
Step 2: Review the variety of options available in the marketplace. While certainly not a list of every imaginable option, click here for a guide to the most common claim audit approaches. If you have less common objectives, you may need to do additional investigation regarding available options. Google searches will turn up a wide variety of vendors and many audit approaches with various nuances.
Step 3: Analyze results of Steps 1 and 2. The chart below shows the correlation between the 6 common objectives and the 3 basic approaches. Pick the option that most effectively achieves your objectives. Of course, you will need to consider other objectives as well, such as your audit rights and restrictions in your ASO Agreement, your budget and your desired time frame.
Don’t mistake your claim audit approach with other types of audits….thought it is common for them to be bundled together and/or included in a claim audit approach. They can have different objectives. Other audit types include:
- Operational review
- Dependent eligibility audit
- Performance guarantee review
