ICAPS SERVICES: AUDITS
ICAPS designs and conducts audits of...
- Self-Funded Health, Dental and Disability Plans (Pre- and Post-Implementation)
- Self-Administered Health, Dental and Disability Plans
- Carve out benefit plans such as Pharmacy and Mental Health
- PPO, Point of Service and HMO Plans
- Internal Audit Programs
- Recovery Audits
- Specific and Aggregate Claims
The ICAPS project manager will lead you through every phase of an audit. Working with you, ICAPS will review your administrator's procedures, identify areas where problems exist and recommend solutions. The audit will assure you that the plan dollars issued are for eligible participants for services which were medically necessary and paid within established reimbursement levels. When a more in-depth review of administration practices is indicated, you may want to have an Operational Review performed.
ICAPS SERVICES: OPERATIONAL REVIEWS
ICAPS can conduct a Claim Management (Operational) Review that determines the reasons for a high error rate. For a Claim Management Review, fourteen administrative areas are reviewed. Some of these areas are...
- Claims Administration (Workflow)
- Staffing, Training
- Case Management
- Levels of Authority
- Check Control & Security
ICAPS SERVICES: CONSULTING SERVICES
- Establishing audit programs for self-monitoring
- Comparison with like-size companies to determine areas of administrative costs
- Review large Case Management procedures, both current and retrospective
- Resource on medical and dental claims processing questions
- Review claim data and utilization reports to identify over-utilized services
- Working with employers to develop Performance Agreements with Administrators