TFG’s 100-percent audit technology re-adjudicates and reviews every claim. We make sure all payments comply with plan rules and identify all exceptions. Also, we can select a strategically focused sample of claims for on-site validation. Tests have shown that we can identify four times as many error categories and up to 14 times as many overpayments compared to random sampling. Knowing what went wrong, with the individual claim, allows us to determine what can be done to prevent future overpayments. It also helps us guide you toward significantly higher recoveries.
In comparison, random sampling applies a statistical selection methodology to the claims data. It provides only a statistically valid understanding of the error types and rates, which creates a reasonable estimate of the percentage of claims that have been incorrectly administered. It, therefore, does not provide practical or detailed information to make significant process improvements and has significant recovery limitations.