Health Care Claims Audits

Almost all health plans pay self-funded health and welfare benefits claims in accordance with a plan of benefits. Health care claims audits are 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.

With the dramatic increase in health care costs, MKA 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 the 1960s, MKA has provided a straightforward, cost effective and 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.

For additional information: contact us