A Different Take On Claims
You will never see or hear EPS boast about having a high auto-adjudication rate on claims. All that really means to a client is that claims are paid fast and that the TPA’s overhead is lower – not that claims are paid in the manner that they should be paid.
With PPO discounts becoming less and less relevant in today’s market, Plans must be much more attentive to the actual “charges” being put on claims. An auto-adjudication system that allows a charge that is not prudent, even if it gets a “good” PPO discount, is not effective protection of Plan assets.
Even with auto-adjudication built into our claims system, experienced adjusters review claims. It is in those reviews that we bring value to the client. Only the eyes of an experienced adjuster can truly evaluate claims to determine if the charges meet the ERISA prudency test.
On average, EPS adjusters have over 20 years of industry experience and have been with EPS for more than 10 years. This is level of experience cannot be built into any software algorithm. If you were to turn your checkbook over to someone to pay your bills, do you want them to simply find the fastest way to pay your bills or do you want them to examine each bill and carefully review to make sure bills are paid correctly?