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Claims Integrity

Every medical plan, regardless of its size has many moving parts. Ensuring that claims are paid properly, and that you
are being properly billed is key to keeping your costs in line with your planning.

Our Double Check Audit Engine™ rechecks and verifies claims in real time

With Leading Edge as your partner, nothing slips through the cracks. Our proprietary audit engine double checks every single claim in real time via a second independently programmed system before it is paid. Every flagged claim is then analyzed by our staff of expert claims specialists who will request further documentation, review the issue with plan administrator, or send back an inappropriate claim.

What to ask any TPA or third party auditing service you are considering:

Does your TPA or audit service review each claim in real time?

Most audit services review for corrections after claims are paid, and they are usually only randomized sample audits. This can translate into inaccuracies, questionable billing, and over-billing. It also prevents the wasteful practice of tracking down providers after the fact (called ‘pay and chase’), and helps you avoid delays in claims reimbursements to employees.

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Who reviews claims?

Many TPAs use inexperienced account personnel to review claims. Leading Edge employs dedicated experts who not only know every detail of your plan, but also make it their business to know every creative billing practice.

We have strong relationship with providers. If there is an issue, we speak with them directly, even if it means going right to the head of a hospital.

Leading Edge offers a wide range of fee structures for our Plan Compliance and FWA&E services, and work with you to determine which is best for your needs

CALL-OUT : LEA reviews 100% of all claims before they are paid. Most 3rd party auditing companies review only a small random sample of claims.