Simple Performance Analysis

MBA analysis of up to three years claims data with intent to identify any possible areas in which the TPA may be underperforming. Areas considered are PPO discounts, plan adherence, coding, and eligibility accuracy. A report is provided upon completion of the review highlighting the results good or bad.

Contingency Audit

MBA review of up to three years claims data concentrating on all claims payments over $1,000.00. This type of audit is usually a three step process. First to review the data, then schedule a on site audit where the Benefits Administrator is given the opportunity to defend their position on errors, and last to recover the overpayments. This type of audit will not only locate and recover overpayments but like the Performance Analysis a report of the audit findings will be provided upon completion of the audit process.

Aggregate Claim Review

MBA reviews all aspects of eligibility, claims processing, and payment procedures to ensure compliance with the Stop Loss Policy.

Expert Witness

MBA will review relevant data making use of MBA claims experience to make an assessment of the data that can be used to present an expert opinion in court.