The objective of medical plans is to ensure claims are processed accurately, following the established plan documents for covered services. With the trend toward outsourcing claim payments to third-party administrators (TPAs), oversight becomes increasingly crucial to maintain these standards. It is where a healthcare auditing company plays a vital role, as they assess the performance of TPAs to verify accuracy and adherence to plan stipulations. Given the substantial sums involved in medical claims, thorough auditing practices are crucial for identifying errors and recovering any overpayments. 
In recent years, technological advancements have significantly improved the auditing process. By integrating human oversight with electronic reviews, the accuracy of audits has reached remarkable levels. Leading claim auditors now review 100 percent of claims paid, moving far beyond the traditional method of random-sample audits. This comprehensive approach allows for a clear understanding of a plan's performance, providing in-house management with essential insights. The pandemic exerted substantial pressure on health plans, prompting many to reassess and learn from the challenges. 
Ideally, self-funded medical and pharmacy benefit plans should undergo continuous monitoring to ensure accurate claim payment. One of the significant advantages of ongoing monitoring is the ability to identify minor errors early on, preventing them from escalating into larger issues. Addressing these discrepancies promptly saves both time and money, ultimately leading to improved service for members. Additionally, recovering overpayments is simpler when the errors are recent and relatively small rather than larger issues that may have occurred over a longer period. 
The increased implementation of audits reflects improvements in the industry's accuracy. It is common for audits to reveal recoverable overpayments that exceed their price. This statistic typically sparks immediate interest from large employers, both corporate and nonprofit, with self-funded benefit plans. There exists a substantial opportunity to reduce healthcare spending while maintaining the same quality of care for employee members. It marks a significant shift away from the outdated practice of infrequent random sample audits, which were primarily conducted to fulfill regulatory requirements.