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.