Visual Analytics • Analytical Monitoring • Information Management

Claim Audits: Are They Necessary?

I remember this story like it was yesterday.  After graduating from college, I accepted a job for an internal audit position for a major airline.  Not long after being hired, my boss told me they had recently conducted a claim audit for their previous medical carrier.  He took me to the storage room that contained our work papers, proceeded to pull several files from a stack and dropped them on a table (yes there were no electronic work papers back then).  After some choice words and an unfavorable description of the former medical carrier, he thumbed through the documents and said “Here, I want you to see this.”  I had no idea what …

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Narrow Networks: Great Idea or White Elephant?

At company parties we sometimes get hooked into a gift exchange game called the White Elephant.  While the rules do vary the object is still the same and that is to take home the best gift.  In the beginning (and during) there is invariably a lot of time bickering about the rules and how to play.  To enhance the fun as well as the disappointment, the game allows other players to steal the most desired gifts.  So while most participants are thrilled to open a gift and get a $35 Starbucks gift card by the end of the gift exchange they get stuck with a bright pink fleece snuggie.

In ancient Asia owning a white elephant was regarded (and still regarded …

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Right of Reimbursement: There’s No Time Like The Present

Early in my career I needed to find a vendor to recover approximately $2.5 million in medical claim overpayments for one of my clients.  After meeting with a couple of cost prohibitive recovery vendors my client’s legal counsel suggested I meet with a well-known subrogation attorney who just recently started-up a subrogation company.  The attorney wasted no time and flew in to meet with me within a couple of business days after our introductory call.  After an hour or so meeting I agreed to visit their offices before I recommended my client utilize them as a recovery vendor.  In short, we agreed to proceed and they commenced to recover the overpaid claims.

During …

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