Page 24 - CPAAC_Spring2018

CLAIMS AUDITS
 EIA – every 2 years
 Interim audits
 How to measure – percentages/pass or fail
o Look at what measured
o Evolving in EIA Standards and what
 What is important to your County vs. TPA (3 point contact/diaries for example)
o Litigation Management
o Excess Reporting and Reimbursements
o Reserving Practices
o Plan of Action
o Proper coding of nature, cause, body part, etc.
 No physical injury/unknown/NOC
o Other
 Pre-meetings before the audit performed

TRENDING/TAILING AND FORWARD INDICATORS

 Program Results Comparison Year/Year
 Goals for the Program
 Closing Ratios
 Actual Inventory

o Pending Inventory Reduction
o Reduction sustainability
 Incurred Changes Reports
 Medical Costs an Containment
o Utilization Review and Bill Review
 Actuarial