TPA Billing Auditor©

Monthly TPA’s Funding and service fee invoices can be very hard to review for payment because they include charges for claims that have developed through months and some even years.

Each funding invoice includes thousands of line items from hundreds of payees like physicians, chiropractors, law firms, and others, in addition to charges for managed care services provided by the TPA like bill review, clinical consultation, telephonic case management, physician review, and others.

Each service fee invoice includes charges that change depending on the contract year. These charges could also change as the claim develops from a medical only claim to a indemnity claim.

INSIGHT uses a proprietary software to analyze these TPA’s invoices in seconds. The software allows the user to combine billing cycles and determine if the charges are correct. It will identify duplicate charges or those applied with the wrong fees. It also provides reports by payee to determine how many times a particular chiropractor or physician was paid to work on patients.