Medical Plan Auditing for
WOULD YOU LIKE TO HAVE CONTROL
OVER YOUR SOARING MEDICAL PLAN COSTS?
our Medical Plan Auditing Focus Sheet.
Plan Auditing Services
our Rising Costs of Health Care Presentation.
The Rising Cost of Health
WHAT IF… You could recover
4 to 8% in cash or billing credits from your organization's health
benefits program from prior years and compound those savings to reduce
current and future costs?
WHAT IF… You were able to control the
cost of your employees medical programs in-house?
A comprehensive audit of your medical plan could be made and the
audit fees would be of no consequence to
It is obvious
that group health benefits is a major budget concern and most confusing when
it comes to your medical plans in the areas of claims adjudication
utilization/rating formulas and administrator’s fees. Considering the efforts expended by managers to hold down
the cost of employee health benefits, the results are more often than not
disappointing. It is our practice to
you of those disappointments.
JAF utilizes state-of-the-art business concepts and acumen in the resolution of the most
difficult management problems. Our professionals are hands-on,
innovative, results-driven, bottom line managers. We are a group of
professionals with over 140 years of accumulated experience and know-how in
the administration of Employee Benefit Plans. We have the expertise
in all areas of the operations of Third Party Administrators, Insurers,
Brokers and Company managed plans. JAF is able to offer its service to any organization without regard for geographic proximity to our location.
We effectively become an extension of your offices minus the overhead and
staffing concerns associated with “doing it yourself.”
JAF is most
confident that we will recover a significant dollar volume from our audit.
With that in mind, it is our practice not to charge any fees until our
client realizes dollar recoveries. Our fees are on a contingency basis
related to any direct savings and rebates in the form of cash or credits.
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For most organizations, health care related costs
represent more than 35% of employee benefit costs, and 15.2% of overall payroll
costs.1 A portion of that is
likely from improper claims adjudication. Therefore, organizations can gain
five key benefits by partnering with JAF on claims audit.
1 March 2004
Employee Benefit News
JAF has extensive auditing experience, including
each staff member having at least five years' experience with managed care
health insurance plans. JAF's staff has audited Health Maintenance
Organization (HMO) Plans, Point Of Service (POS) Plans, Preferred Provider
Organization (PPO) Plans, as well as traditional Indemnity Plans. JAF's
experience leads to higher levels of recovery and shorter audit timeframes.
The complexity of the claims auditing
process--variation in claim forms, contract language, health insurance codes
and administrative procedures--can reduce the effectiveness and efficiency of
TPA, broker, or employer self-audits. This is another reason why you need
the trained and experienced staff of JAF's claims auditors.
Medical Cost Savings.
Your company benefits from recovered
claim expenses that would have otherwise been lost. In addition, you and your
administrator will receive recommendations to help prevent future errors that
increase medical costs.
Knowledge and Control.
Employers rely on their health care
claims administrator for proper and timely adjudication of benefits, and
reporting of utilization & financial data. Decisions based on these data are used as a
cornerstone for benefit plan design and cost control. When the data include
improperly adjudicated claims, your organization incurs unnecessary costs and makes
decisions on future medical claim management based on that incorrect information.
on a claims audit allows your organization to make health benefits
decisions with confidence.
is committed to protecting all information accumulated during the course of
an audit. All data is strictly guarded during the audit and once it is
completed. Your records will be retained in a our facility for a period of
years after the conclusion of the audit and disposed of by shredding each
document. Additionally, JAF will sign Confidentiality Agreements you may
require and will provide a Hold Harmless Agreement in order to protect your
organization, Insurer, Third Party Administrator or any other parties to the
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Do We Audit?