Claims Audit

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Pursuing Fair and Transparent Costs, Line By Line

The ELAP audit program puts pricing limits in your Plan Document that regulates how your medical claims will be paid. These “Allowable Claims Limits” are consistent with ERISA and DOL guidelines and eliminate wasteful spending by identifying the actual cost for a Medical Provider to deliver a service and paying them a fair margin above that cost.

This method moves away from the traditional top-down structure of payment used by PPO Networks, in which a discount is taken off the Providers’ often inflated billed charges and the employer is left in the dark.

Instead of the unregulated charges PPO’s base their discounts on, ELAP works with employers to apply the same fiscal discipline to health care that they demonstrate in all other areas of their business using more transparent and rational sources for determining reimbursement. Specifically, ELAP uses Medicare and the annual cost reports submitted by Providers to the Center for Medicare & Medicaid Services (CMS) as the basis for reimbursement.  We audit your claims, line by line, to make sure that all claims are paid in accordance with the new, rational plan language.

The result is a huge reduction in your healthcare costs and a significant impact to your bottom line.