Transportation Company Recovers Inappropriate Charges During Financial Cycle Review

Challenge

One of the largest transportation companies in the United States had difficulty
producing accurate and reliable data on their health care claims expenditures. They
required an increased level of detail to satisfy internal compliance regulations. Beyond
routine claim audits and reviews, the client needed to verify the accuracy of the nonclaim
aspects of vendor charges.

Solution

The company turned to VitalSpring Integrity, the only end to end financial compliance
and control solution for claims expenditures. Using VitalSpring Integrity, the benefit
finance staff was able to easily produce reports and analyses that were required by
their auditors. These reports included detailed comparisons of claims and eligibility
records, claims and provider payments, vendor invoices and bank allowances. All
financial activity ultimately mapped to their general ledger within the VitalSpring
solution.

Beyond analysis on duplicate and ineligible claims, VitalSpring Integrity also provided
detailed breakdown of non-claim charges by vendor.

The client’s analysis was facilitated through the following Integrity modules: Invoice
Validator and GL Auditor.

Result

VitalSpring Integrity enabled the client to identify over $150,000 of wrongly applied
surcharges for a single claims cycle.

The resulting process improvements included:

• A client-driven vendor review of their entire audit billing systems to ensure
  compliance with the client’s service contract
• Correction and/or refund of wrongly billed amounts
• Installation of VitalSpring Integrity control reports as part of the client’s ongoing
  financial audit processes