Not long ago, self-funded corporate medical plans used random sample audits, conducted primarily as required by regulations. Thankfully, the landscape has changed significantly. Nowadays, medical claim auditors can evaluate 100% of the medical and pharmacy payments processed, leading to improved accuracy, reduced burden on in-house benefits teams, and more effective plan management. Since the advancements in auditing software that began in the '90s and have evolved to today, the techniques used have drastically improved, helping to control costs and enhance plan performance.

For senior management and financial analysts, medical costs are one of the biggest unknowns that can impact a company's bottom line. The previous method of conducting audits long after claims were paid proved inadequate, often resulting in unexpected large cost spikes affecting earnings and stock prices. Now, many companies recognize the importance of regular audits and continuous monitoring of their claim payments. These allow them to identify and rectify errors swiftly, keeping their plans on track and reducing the need for recovery of overpayments. It saves time and keeps budgets on track.

Continuous monitoring services offer a significant advantage in effective plan management. By providing real-time insight into claim payment activities, they make it much simpler to identify and correct errors before they escalate. Continuously monitored plans encounter far fewer issues, and out-of-line costs are quickly addressed. The cost of these services is often minor compared to the savings from preventing payment errors. This monitoring also fulfills the commitment made to employees for a streamlined and effective plan. When operations run smoothly and mistakes are minimized, everyone benefits.

The growing trend of monitoring continuously highlights the value it brings to plans. While claim processors commit to maintaining accuracy and may genuinely strive to do so, nothing rivals the effectiveness of oversight. Human nature dictates that accountability leads to greater caution, which applies to medical and pharmacy benefit claim payments. When in-house plan managers can access solid data, discussions surrounding mistakes and overpayments become evidence-based and less open to dispute—additionally, the monitoring data aids in addressing inquiries from the finance department.