Health Care Claims Audits

Learn more about a Claims Audit

Almost all health plans pay self-funded health and welfare benefits claims in accordance with a plan of benefits. A health care claims audit is designed to assess whether claims are being adjudicated in accordance with the provisions of the plan of benefits, and paid only to, or on behalf of, eligible participants as determined by the provisions of the plan. When Miller Kaplan professionals conduct a health care audit, we provide you with meaningful information so that you make quality decisions.

Miller Kaplan and your Health Care Audit

With the dramatic increase in health care costs, Miller Kaplan recognizes the financial significance to plans of recovering over paid claims. It is equally important that plan participants not suffer the financial burden of under paid claims. Since we’ve began offering this service in the 1960s, each health care audit that Miller Kaplan conducts is straightforward and cost effective. Our partners and professionals follow a practical approach to auditing medical, dental and disability claims on behalf of self-insured health plans. We focus on the adequacy of internal controls for processing and paying claims to ensure that claims are being paid:

• In accordance with your plan of benefits or provider contractual agreement.
• Using the proper negotiated rate for your plan to network providers of the plan.
• Only to, or on behalf of, eligible participants as determined by the rules of the plan or other agreement.

To find out more about a health care audit or any other claims audit, please contact us online or call us at (818)769-2010.