Quality Assurance Audit

KBM Management's Quality Assurance Claim Audit provides a comprehensive review of both the administrator’s performance and the effectiveness of the benefit program.  We have been successful in reducing administrative errors, recouping claim dollars, and enforcing eligibility requirements.

KBM's health and workers’ compensation team are knowledgeable in the law and in the process and procedures of all aspects of claims.  With continuous changes in legislation, there is an increasing importance of the audit as a management tool for both the plan and administrator.  There is no other product on the market today that achieves the results of the KBM Management Quality Assurance Claim Audit.

Audit components include, but are not limited to:

• Benefit Interpretation
• Statutory Limitations and Exclusions
• Medical necessity
• Claims Administration
  • Turn-around time based on statutory limitations and exclusions
  • Benefit calculation accuracy
  • Eligibility controls
  • Duplication of payments
  • Use of physician panels
  • Standards of measurements
  • Review of policy and procedures
  • File organization
• Cost Controls
  • Third party liability reimbursements
  • Utilization review, therapy, etc.
  • Workers’ Compensation Special Funds
  • Integration of safety procedures and developed patterns
  • Claims costs
  • Reserve calculations
  • Review timely closing of claims

The KBM Management Claim Audit is provided as part of our comprehensive plan management services or on a fee-for-service basis.  Call us today for more information on this dynamic product.