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Implementation Claim Audits are a Must

Medical claim auditors provide the most effective oversight mechanism for large employers managing medical and prescription plans. This emphasizes the importance of conducting implementation audits when new processors come on board—namely, third-party administrators (TPAs) for medical claims and pharmacy benefit managers (PBMs) for prescriptions. While TPAs and PBMs often have considerable experience, integrating a new project within their systems requires meticulous attention to numerous details. Auditors play a critical role in validating the accuracy of this setup to your plan’s provisions.

Typically and optimally, an implementation audit is scheduled for 90 days after a new claims processor starts their role. By this point, there is enough operational data to make the audit beneficial, while it’s still early enough to identify any significant issues before they escalate into costly problems. Addressing overcharges and erroneous payments is more manageable soon after they occur, rather than waiting months. Additionally, implementation audits ensure member…

TFG Partners
4 days ago · joined the group.

5 Tips for Planning the Perfect Beach Maternity Photoshoot on Oahu

A beach maternity photoshoot on Oahu is the perfect way to capture the beauty of pregnancy amidst the island's breathtaking scenery. With its golden sands, turquoise waters, and stunning sunsets, Oahu provides a naturally picturesque backdrop for photos you’ll treasure forever.

Planning the perfect maternity shoot involves more than picking a scenic spot. To make it truly special, you’ll need a clear vision and thoughtful details that align with your style and comfort. From choosing the right time of day to selecting outfits, getting everything right will ensure your photos are as radiant as this incredible milestone in your life.

First, consider the timing of your photoshoot. Scheduling your session during the early morning or just before sunset, known as the "golden hour," offers the most flattering lighting. During these times, the light is softer, reducing harsh shadows and enhancing the natural colors of the beach, ocean, and sky. Golden…


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Megan Moura
4 days ago · joined the group.

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