Mercer Audit
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Overpaid claims drain budgets and put employers at risk.
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ERISA fiduciary duties demand proactive auditing to protect employees and your organization.
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ASO vendors' incentives often prioritize speed over precision, leaving you vulnerable.
The hidden costs of healthcare claims mismanagement
Why traditional random sample auditing falls short in a complex landscape?
A payment integrity audit of all claims can tell you where your benefits and administration are on target and where they’re off the mark. A payment integrity audit can support:
ERISA and fiduciary obligation: Plan sponsors have a fiduciary obligation to ensure that health plans are working in members’ best interest. You may have an implicit responsibility to audit your health plan coverage and ensure health plan dollars are being spent accurately.
The Consolidated Appropriations Act: raises transparency requirements for health plans; an payment integrity audit lets plan sponsors verify disclosed pricing), demonstrate fiduciary oversight, and quantify any financial exposure—reducing regulatory and reputational risk.
Sarbanes–Oxley duties: Before signing off on the benefits portion of a balance sheet, an organization has the responsibility to periodically audit health, medical, dental or pharmacy benefits payments. An audit validates your statement.
Compliance validation: Internal or external independent auditors frequently ask about a healthcare audit. Are you confident that what you are reporting on financial statements provides an accurate representation of what’s been paid? A plan payment integrity audit validates compliance and identifies areas that need refinement.
Leveraging AI to validate your payment integrity: Precision, Evidence, Full Visibility, Accountability and Recovery. Leveraging the power of AI, Mercer Audit transforms claim payment integrity auditing from reactive guesswork to proactive, evidence-based identification and remediation.
Custom AI rules engine: Leverages AI to build a tailored set of rules from your plan documents, policies, and provider rates — ensuring audits are 100% aligned with your specific setup.
Hard evidence for every discovery: Errors are backed by verifiable data, - never speculation — giving you defensible documentation for recoveries and peace of mind.
Claims transparency: Gain full line-of-sight into payment accuracy across every claim, spotting anomalies to mitigate risks.
Trust Mercer for your health plan audit
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Dedicated team of specialistsAll of our performance audit staff have over 10+ years of experience within the insurance carrier and audit world. Performance assessment is our exclusive focus.
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Depth and breadth of experienceWe conduct more of the most-requested types of payment integrity audits than any other firm. Our objective, unbiased review helps plan sponsors leverage their health and wellness benefits offerings and provide greater value to beneficiaries.
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Proven solutionsOur team can draw insights and make recommendations that enable discussion about plan administrator performance and needed solutions.
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Benchmark resourcesMercer clients have access to an extensive audit database comparing vendor performance, established standards for measuring performance, and best practices for evaluating operations.