A Technological Approach to Claims Audit

The last two weeks I wrote about the ineffectiveness of traditional claims audit and the inherent conflict of interest some companies face when they perform such audits. This week I’d like to introduce a company that brings a different approach to the industry: HR Best Practices.

HR Best Practices was founded by Howard Gerver five or six years ago. I first met Howie 3 years ago at the 2003 HRO World Conference. From the beginning, I could tell he was one of those people who just plain “get it”. Since then I’ve found out more about his company and approach to health care claims audit. I believe it’s unique. If anyone reading this knows of other companies taking a similar approach, I’d love to know about them.

Essentially, HR Best Practices employs proprietary financial management and reconciliation tools to perform 100% audit of claims for three primary purposes:

• Cost Recovery
• Cost Containment
• Cost Avoidance

For Howie, claims audit is ROI driven. In fact, depending on the situation, I’ve seen HR Best Practices offer something I haven’t seen anywhere else in the industry: an ROI guarantee. The flexibility of the approach makes it applicable to all types of claims data. The audits can be geared towards areas such as point-in-time eligibility, dependent audit, coordination of benefits, subrogation, disease management, cost benchmarking, etc.
There are a couple of White Papers available on thier Website here and here which give some really good information and further insight on the approach and application of the technology.
As I look at it, I definitely believe it is the approach of the future, making the traditional claims audit obsolete. I assume there are other companies taking this approach, but haven’t run across them yet. As I said earlier, if there are others offering this comprehensive approach, let us know.

For now, it seems a no-brainer that this is the way to go to get a guaranteed return on investment and demonstrable cost recovery, containment and avoidance as a result.
About the author – Donald Glade is President and Founder of Sourcing Analytics, Inc., an independent consulting firm specializing in helping companies optimize their HR / benefits / payroll service partnerships through relationship management, financial analysis, and process improvement.