Audit Standards Tighten for 2018

Thursday, December 14, 2017 | 0

Claims administration services will need to score better in 2018 than they did this year to pass the initial stage of annual audits and avoid a more stringent review of claim files.

The Division of Workers’ Compensation said the Profile Audit Review performance standard for 2018 will be 1.47573, down from the PAR standard of 1.47885 in 2017.

Claims administrators that receive a score equal to or less than the standard set by the division will be required to pay any outstanding compensation but will not face administrative penalties. Shops that score higher will be subject to a heightened Full Compliance Audit, or FCA.

The FCA standard for 2018 will be 1.67487, the same as it was in 2017.

Administrators that score at or below the FCA standard will be required to pay all unpaid compensation and be assessed penalties for all violations relating to late or unpaid compensation.

The DWC will review an additional sample of claims for any audit subject scoring higher than the FCA standard. These shops will be assessed penalties for all identified violations.

The 2018 PAR and FCA standards are based on the audit results from 2014 through 2016.