ICAPS eAUDIT SERVICES

An ICAPS eAudit is an electronic review of your claims. The purpose of the audit is to determine if your claims are being administered according to the provisions of the plan.

HOW DOES IT WORK?

Electronic reviews through ICAPS are tailored to address each client's unique needs and concerns. Prior to beginning the audit, ICAPS reviews the plan's Summary Plan Description (SPD), Administrative Services Agreement (ASA) and applicable claim processing performance standards. We then provide you with a list of audit options and associated costs and you select the review items that are most important to you. Once the selection is made, a data request will be made to your administrator.

WHAT IS INCLUDED IN THE AUDIT?

We have a standard list of items to review but each client can select the review items that best meet their needs. Here is a sample of the items reviewed...

• Possible duplicate claims
• Ineligible charges
• Plan maximums
• Plan limits
• Deductible and coinsurance accumulators
• Multiple surgical procedures
• Claims paid before or after effective date
• Co-payments

HOW MUCH DOES IT COST?

The cost of an eAudit depends on the level of review you select. The fee is a set dollar amount per employee per year.

NOTE: It's important to review your ASA Agreement as it regards audits since many administrators only permit performance-based audits and not electronic reviews.