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Our audit provides a comprehensive review of both the administrator’s performance and effectiveness of the benefit program. KBM has a health and workers’ compensation team knowledgeable in the law and in the process and procedures of all aspects of claims. With continuous changes in legislation, there is an increasing importance of the audit as a management tool for both the plan and administrator.
We believe there is no other product on the market today that achieves the results of the KBM Claim Management Audit. Audit components are outlined below:
- Benefit Interpretation
- Statutory Limitations and Exclusions
- Medical necessity
- Claims Administration
- Turn-around time based on statutory limitations and exclusions
- Benefit calculation accuracy
- Eligibility controls
- Duplication of payments
- Use of physician panels
- Standards of measurements
- Review of policy and procedures
- File organization
- Cost Controls
- Third party liability reimbursements
- Utilization review, therapy, etc.
- Workers’ Compensation Special Funds
- Integration of safety procedures and developed patterns
- Claims costs
- Reserve calculations
- Review timely closing of claims
e-mail...
Solutions@KBMemail.com
address...
KBM Management, Inc.
5860 Heritage Landing Drive
East Syracuse, New York 13057
phone / fax...
800.653.8305 / 315.449-3115
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