Risk Management Archives – Academic HealthPlans
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Claims are Key – a Guide to Claims Audits and Readiness Assessments

Costs and Coverage, Risk Management

Properly adjudicated claims are a key goal of claims administrators, colleges and universities, and student members alike.

Inaccurately processed claims can end up being timely and costly. Overpaid claims will negatively affect claims experience leading to higher premium renewals. These can be especially harmful for self-funded plans where the college or university holds the risk. Underpaid claims can lead to additional time processing claims and handling appeals and some unhappy members.

The good news is that claims administrators take this very seriously and have comprehensive processes in place to ensure timely and accurate claims processing. That said, there may still be some that initially slip through the cracks.

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