This site works best with Javascript turned on. You may experience some disabled features without it.

Claims Quality Compliance

Your claims payment, medical policies, benefit designs and provider contracts need regular check-ups!

T3's AuditPoint Platform facilitates a more comprehensive approach to improving claims accuracy. We have designed audits to ensure contracts are applied correctly, benefits are configured appropriately and reporting is complete. Having all the information underlying these different audit types in one place simplifies Root Cause Analysis on recurrent errors, to discover what is driving them, regardless of type or origin, and identify the most promising areas for improvements.

Quality Audits

Working together, let's start writing a new chapter in improving quality!

Reliance on statistical audits to report on a variety of quality metrics, including those surrounding the payment and financial accuracy of claim processing or MTM reporting requirements lead to variances from one reporting cycle to another that is hard to explain. At the same time these reports are separate and apart from audits done outside the Quality Department, such as cost containment vendors or teams focused on minimizing prompt payment interest and penalties.

T3 has taken a holistic approach to conducting Quality Audits and generating the mandated quality reports. By implementing Quality Audits that analyze 100% of claims and combining results from other auditing activities, we are able to help our client partners conduct a comprehensive Quality Audit approach and produce reports that are more inclusive and complete.

Benefits Compliance Audits

Configuring claims systems and ensuring accuracy can be tough!

Benefits applied incorrectly translate into incorrect claims payment, and in turn, unhappy customers. T3 digs deep to understand the configuration of your plan benefits and creates custom configuration-driven audits that ensure that claims are paying accordingly. The audits are thorough, comprehensive and applied to 100% of the claims electronically, with automatic back sweeps to find all prior errors. By conducting systematic Root Cause Analysis we are also able to identify problem areas as well as helping deploy solutions to fix and prevent recurrence.

Peer Review and Statistical Audits

Dotting the "i"s and crossing the "t"s!

Quality Audits required for compliance reporting often include a variety of audits that use statistical random sampling to measure overall payment and financial accuracy rates, or monitor performance of claim examiners, instead of targeting a specific type of claim or error. T3 can build and automate these audit processes for you, increasing your productivity and provide a consistent and repeatable solution.