Claims review returns 6-to-1 on investment

Problem: The Corporate Board of a 1,000-employee company wanted an audit of health plan claims to see if any claims were excessive or inappropriate. The HR staff agreed an audit was needed but had no time to do one internally and only a limited budget.

Action: Health Decisions was retained and handled all aspects of the audit. HR involvement was limited to two conference calls, one presentation meeting and selected case follow-up. Total HR time investment was less than four hours.

Result: Health Decisions recovered funds that not only covered the initial audit retainer but actually produced a $6-to-$1 positive return-on-investment. The audit, instead of costing time and money, returned revenue to the company. The Board received a formal report of findings noting recovery areas and including suggested remedial steps to be pursued with the health plan payor.