Quality Control & Fraud Prevention
A&I takes our responsibilities seriously and have a variety of programs in place to provide the highest quality service and prevent financial loss.
We conduct thorough auditing, including 100% post-implementation, payment threshold and random audits. We utilize peer review and send daily positive pay files to the bank. Our stop loss and subrogation programs are comprehensive and include daily monitoring of potential Plan reimbursements.
We evaluate our fraud policy annually or as needed. Our on-site fraud specialist regularly monitors potential fraudulent activity and ensures our systems are flagged appropriately. We have built in system edits and provide on-going education and training. In addition, our policy includes separation of duties and background checks for our employees.
We measure several key processes, including daily turnaround times, phone call trends, accuracy and timeliness. We monitor customer service phone calls and provide coaching to our team members for professional development.