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PRG-Schultz understands that verifying medical claims is a difficult and costly exercise requiring special skills and resources. Whether you're a self-insured business or an HMO, we have the data mining tools and experienced audit professionals to perform a focused, cost-effective review of 100% of your medical claims-including verification and recovery of any overpayments.
Self-Insured Services
If you're self-insured, PRG-Schultz gathers electronic data from your Human Resources system and contacts your Third Party Administrator (TPA) to receive detailed claim history data for all claims processed during the review period. Then we review the two data sets with our proprietary audit software to:
- Analyze your eligibility requirements
- Identify the medical claims to be reviewed on-site at the TPA
- Review the monthly billings from the TPA for discrepancies
- Validate potential overpayments with your TPA
- Arrange for recovery of any overpayments
HMO Services
For HMOs, we will gather your claims processing data and review your service agreements with various healthcare providers. We then analyze your claims with our proprietary audit software to:
- Perform multiple proprietary queries on your data
- Isolate potential overpayments related to pricing or processing costs
- Validate potential recoveries with service providers
- Secure refunds or credit memos
Our services are performed on a contingency basis - no recovery, no fee.
In addition to recovering overpayments, we will also help you improve your processes to manage healthcare claims. This added value creates future cost savings and assures that your healthcare claims are being processed accurately.
Contact us today to discuss how we can help you reduce your medical costs by recovering overpayments.
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