Internal Audits
MIS, Inc. conducts internal audits for Third Party Administrators by reviewing claims that are manually adjudicated as well as auto adjudicated by the claims system.  We provide a service by ensuring the TPA that the information is programmed correctly into the claims system and the examiners are providing quality work.  Our services also afford a comfort level to the TPA clients by providing an outside source to audit the claims.  The audits are certified by MIS, Inc. and are made available to the TPA client groups.  Because of our vast experience in conducting external audits for our clients, MIS, Inc. is able to advise the TPA of items that should be addressed prior to the review by the outside audit firm.

Mullally Insurance Services, Inc. emerged from the experience of professionals with both health insurance and claims administration backgrounds.  They realized that the accuracy of claims administration increased dramatically when the claims examiners are subject to monthly audits.

More information about our Internal Audit Services

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External Audits

The rising cost of medical care is forcing more employers and their consultants to become involved in their own employee benefit programs.  That involvement is changing both the patterns of obtaining benefits and the methods of funding them.

The employer is now finding it necessary to assume a larger portion of the risk.  Myriads of managed care health products have emerged to help the employer and their consultants control their health care expenditures.

Information has become the most powerful weapon in the war on escalating medical costs.  Utilization review programs, catastrophic case management, and data analysis packages all attempt to generate reports to help identify and analyze utilization patterns.

Employers and their consultants are relying on these reports to make crucial decisions about plan designs and cost containment measures.  The astonishing truth is that most of these decisions are made without ever questioning the integrity of the basic information used to generate the reports.  Millions of dollars are spent each year for the purchase of managed care programs.  Nothing is spent on auditing the credibility of the most basic source of information…

More information about our External Audit Services

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Collections and Negotiation

Mullally Insurance Services, Inc. offers two types of negotiations:

  • We negotiate claim payments for a lower percentage under specific circumstances such as, insolvent companies funded by state Guaranty Associations, and non-network claims where there is no preferred network for TPA’s or insurance companies.
     
  • We can also work with Third Party Administrators/Insurance Companies in collecting overpayments from providers, clients, or employees.

The fee for this service is based upon a percentage of savings or recovery for the negotiations and collections.

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Preferred Provider Organization Comparison

Due to the high competition with Preferred Provider Organizations (PPO), self funded employers are relying on the information submitted by proposals from the Third Party Administrators/PPO.

Our service provides the employer with a unique look at what the discounts would be for local providers and hospitals in their area providing they were to award the contract to the Third Party Administrator(TPA)/Insurance Company.

This process makes the decision easier for our client prior to awarding the contract to the TPA/Insurance Company.

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We are now offering the ability to adjudicate claims in a backlog situation for our clients.  Our focus is on quality and quantity.   Both must be provided, otherwise, the help is useless due to having to reprocess claims and major adjustments.  We can provide a sense of comfort to you and your group clients in knowing that the claims will be properly processed in a timely matter.

Reasons for choosing MIS Inc.:

  • Experienced examiners who have knowledge of major claims systems such as  Basys, Healthaxis, Rims, Facts, Facets, Claimfacts, El Dorado, and Genelco, etc.
     
  • No travel expenses – examiners can process claims from their homes via internet/citrix/vpn client
     
  • Fees based upon a per claim basis, not an hourly rate.  This will enable the Third Party Administrator or Insurance Company to know exactly what their expenditures will be on a per project basis.
     
  • MIS, Inc. is an auditing firm, therefore, the per claim fee includes a 2% audit on our examiners which is reported to the client each week.
     
  • No contracts.  Examiners are available on an “as needed” basis.

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Mullally Insurance Services Inc.  ◊  2665 N. Atlantic Ave, Suite 325  ◊  Daytona Beach, FL  32118
Phone: (813) 973-8700