When an overpayment is found, we pursue the recovery and report what came back.
A finding only matters if the money returns to the plan.
Where overpayments come from.
Common sources.
Processing Errors
Claims paid at the wrong rate, twice, or under the wrong benefit.
Eligibility Gaps
Claims paid for people who were not covered on the date of service.
Coordination Misses
Another coverage should have paid first.
How it proceeds.
We follow it through.
Document the Error
We write up what was paid, what should have been and why.
Pursue Repayment
The recovery request goes to the responsible party.
Track the Result
We follow it until it is resolved.
What you see.
Results show in the numbers.
Amounts Recovered
You see what came back, not just what was found.
Patterns
Repeated errors are flagged so they stop.
In Your Review
Recoveries appear in the indicators we review with you.
Questions Employers Ask About This
Is every overpayment recoverable?
Not always. Contract terms and time limits apply, and we tell you what is realistic.
Does recovery take long?
It varies by case and by who is responsible for repaying.
Where does recovered money go?
Back to the plan, so it shows up in your plan costs.
Related guides.
From Renewals to Results: The Broker Playbook
The full playbook.
Claims Audits That Review Every Claim, Not a Sample
Every claim, not a sample.
Dependent Eligibility Verification for Group Health Plans
Verification done fairly.
Want this applied to your renewal?
Send us the renewal and we will run it through DATUM and show you where the number comes from.
Your renewal letter
Your census
Your current plan documents
Your renewal date
Rough answers are fine. We build the numbers from there.
Laws and rules referenced
Employee Benefit News: Renewals to Results — Opinion piece on brokers moving from plan shopping to data-driven advisory work.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
Switch to CFH. Unhappy with your broker? Your employees won’t notice. You will. →
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