Formally, HDM, Inc: We turn massive amounts of employees healthcare claims data into actionable information, which empowers our customers to take corrective actions and negotiate settlements with TPA's and PBM's.
The Audit & Compliance service offering from Thomson Reuters is a comprehensive suite of capabilities providing an assessment for both the financial accuracy of claims adjudication and the proper administration of the benefit from a plan design perspective.
We can uncover two main types of problems quickly and efficiently, including administrative errors and plan design issues. At the core of this service offering are the BenefitsAudit and BenefitsWatch solutions that can help to uncover these common errors:
Other party liability
Incorrect coinsurance benefit levels
Services paid for excluded benefits
Billing and mis-coding
Duplicate claims paid
Eligibility provided for terminated members
Use this information to pinpoint problem areas where process enhancement is needed. Uncover cost-saving opportunities and confirm compliance with contract terms and plan provisions.