THIRD PARTY ADMINISTRATORS PERFORMANCE AUDIT
DESIGNED FOR
Self Funded Group Medical Programs
Self Funded Workers Compensation
Programs
REASONS TO AUDIT
Recovery of monies due to overpayments, duplicate payments, failure to adhere to performance standards, failure to make accurate and timely claims against stop loss carriers and failure to pursue subrogation or coordination of benefits.
Good business practice to track handling of money
Audit leads to improved TPA performance due to sentinel effect
Audit provides objective evaluation
of TPA service
SCOPE OF THE AUDIT
Adherence to laws and contractual performance standards
Conformance to benefits schedules and managed care arrangements
Accuracy and timeliness of payments
Accuracy and timeliness of claims
against stop-loss insurers
OTHER RELATED SERVICES
Development and/or review of TPA contracts and performance standards.
Review and analysis
of stop-loss attachment points and limits of coverage.
CONTACT
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