ICAPS AUDIT SERVICES IN DETAIL
HOW DOES AN ICAPS AUDIT WORK?
There are three phases to the audit process. The example below is based on a performance audit.
- INVESTIGATION
ICAPS audits a statistically valid stratified random sample of paid claims to review eligibility, Coordination of Benefits, subrogation, plan provisions, pricing, and re-adjudication of the payment. - REPORT
ICAPS provides you a thorough report on the findings of the audit. Recommendations, when necessary, are made for improvements: plan design, claims processing, administrative procedure and policy. - FOLLOW-UP
At the client's request, ICAPS will return to monitor the effectiveness of any changes to the administration of the employer's plan due to the audit findings.
Other audit options are...
- TARGET AUDITS
The Client can identify the benefit that they specifically want reviewed. - ELECTRONIC REVIEW
ICAPS has the technology and expertise to efficiently review your claims data electronically, from wherever it is processed. Read more about our eAudits.
Electronic audits enable the review of 100% of your medical claims for inaccuracies and overpayments; this includes duplicate payments, non-covered expenses, deductible and co-pay accumulator inaccuracies, in addition to missing or outdated procedure or diagnosis codes.