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Claims Audit & Consulting Services for Health Insurers

Avoid overpayments and facilitate recovery efforts—get an objective third-party review of your claims administration with Claims Audit & Consulting Services from Perot Systems.

Challenge
In an increasingly competitive market, health claims administrators must adjudicate claims accurately to control costs.

Solution
Perot Systems offers customized claims audit and consulting services that provide health insurers with qualified, unbiased third-party insight into claims processing and business office operations.

Our audit team members have extensive experience in all facets of healthcare claims administration. To ensure the best possible results for our customers, we require that every auditor assigned to a project must have had claims processing experience within the last 12 months.

Our auditors follow a specific, proprietary methodology for re-adjudicating claims. Auditors review all claim actions from eligibility checking to finalization of the claim. Services include:

• Audit and Recovery. Trained associates conduct a quality review of claims processes and operations, identify key overpayment trends, and support recovery efforts.
• Audit Outsourcing. Our service center audit staff absorbs all or part of your health plan's audit function.
• Auditor Support. Audit professionals provided by Perot Systems can supplement your health plan's in-house processes or special projects on a temporary basis.

Results
With Claims Audit & Consulting Services from Perot Systems, your organization can enjoy:

• Greater insight into your organization's claims administration
• Cost controls from properly adjudicated claims
• Identification of overpayment trends and support
  for recovery efforts
• Higher quality of claims processing than may be possible within the organization