{"id":590,"date":"2006-10-03T03:25:08","date_gmt":"2006-10-03T11:25:08","guid":{"rendered":"https:\/\/systematichr.com\/?p=590"},"modified":"2006-10-10T05:45:16","modified_gmt":"2006-10-10T13:45:16","slug":"a-technological-approach-to-claims-audit","status":"publish","type":"post","link":"https:\/\/systematichr.com\/?p=590","title":{"rendered":"A Technological Approach to Claims Audit"},"content":{"rendered":"<p>The last two weeks I wrote about the <a href=\"https:\/\/systematichr.com\/?p=576\" target=\"_blank\">ineffectiveness of traditional claims audit<\/a> and the <a href=\"https:\/\/systematichr.com\/?p=589\" target=\"_blank\">inherent conflict of interest<\/a> some companies face when they perform such audits.\u00a0 This week I\u2019d like to introduce a company that brings a different approach to the industry: <a href=\"http:\/\/hrbestpractices.com\/index.htm\" target=\"_blank\">HR Best Practices<\/a>.<\/p>\n<p>HR Best Practices was founded by <a href=\"http:\/\/hrbestpractices.com\/About_Us\" target=\"_blank\">Howard Gerver<\/a> five or six years ago.\u00a0 I first met Howie 3 years ago at the 2003 <a href=\"http:\/\/www.hroworld.com\/\" target=\"_blank\">HRO World Conference<\/a>.\u00a0 From the beginning, I could tell he was one of those people who just plain\u00a0\u201cget it\u201d.\u00a0 Since then I\u2019ve found out more about his company and approach to health care claims audit.\u00a0 I believe it\u2019s unique.\u00a0 If anyone reading this knows of other companies taking a similar approach, I\u2019d love to know about them.<\/p>\n<p>Essentially, HR Best Practices employs proprietary financial management and reconciliation tools to perform 100% audit of claims for three primary purposes:<\/p>\n<ul>\n<li>Cost Recovery<\/li>\n<li>Cost Containment<\/li>\n<li>Cost Avoidance<\/li>\n<\/ul>\n<p>For Howie, claims audit is ROI driven.\u00a0 In fact, depending on the situation, I\u2019ve seen HR Best Practices offer something I haven\u2019t seen anywhere else in the industry: <strong><em>an ROI guarantee<\/em><\/strong>.\u00a0 The flexibility of the approach makes it applicable to all types of claims data. The audits can be geared towards areas such as point-in-time eligibility, dependent audit, coordination of benefits, subrogation, disease management, cost benchmarking, etc.<\/p>\n<p>There are a couple of\u00a0White Papers available on thier\u00a0Website <a href=\"http:\/\/hrbestpractices.com\/images\/pdf\/bc06june.pdf\" target=\"_blank\">here<\/a> and <a href=\"http:\/\/hrbestpractices.com\/images\/pdf\/adpwp_sep2005-3.pdf\" target=\"_blank\">here<\/a> which give some really good information and further insight on the approach and application of the technology.<\/p>\n<p>As I look at it, I definitely believe it is the approach of the future, making the traditional claims audit obsolete.\u00a0 I assume there are other companies taking this approach, but haven\u2019t run across them yet.\u00a0 As I said earlier, if there are others offering this comprehensive approach, let us know.\u00a0<\/p>\n<p>For now, it seems a no-brainer that this is the way to go to get a guaranteed return on investment and demonstrable cost recovery, containment and avoidance as a result.<\/p>\n<p><em><strong>About the author<\/strong> \u2013 <a href=\"https:\/\/systematichr.com\/?author=5\" target=\"_blank\">Donald Glade<\/a> is President and Founder of <a href=\"http:\/\/www.sourcinganalytics.com\/\" target=\"_blank\">Sourcing Analytics, Inc.<\/a>, an independent consulting firm specializing in helping companies optimize their HR \/ benefits \/ payroll service partnerships through relationship management, financial analysis, and process improvement.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The last two weeks I wrote about the ineffectiveness of traditional claims audit and the inherent conflict of interest some companies face when they perform such audits.\u00a0 This week I\u2019d like to introduce a company that brings a different approach&#8230;<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","footnotes":""},"categories":[24,27,33,19,2,35,36,3],"tags":[],"class_list":["post-590","post","type-post","status-publish","format-standard","hentry","category-benefits-management","category-data-metrics","category-finance","category-topics","category-hr-technology","category-tco","category-vendor-management","category-vendors"],"_links":{"self":[{"href":"https:\/\/systematichr.com\/index.php?rest_route=\/wp\/v2\/posts\/590","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/systematichr.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/systematichr.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/systematichr.com\/index.php?rest_route=\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/systematichr.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=590"}],"version-history":[{"count":0,"href":"https:\/\/systematichr.com\/index.php?rest_route=\/wp\/v2\/posts\/590\/revisions"}],"wp:attachment":[{"href":"https:\/\/systematichr.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=590"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/systematichr.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=590"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/systematichr.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=590"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}