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Sweetwater County approves third‑party audit of self‑funded health claims
Summary
Commissioners authorized a Loomlight master service agreement to audit UMR claims processing for the county's self‑funded health plan; the audit is estimated at $29,650 and will run several months to reconcile systemic issues and plan design alignment.
The Sweetwater County Board of County Commissioners approved contracting with Loomlight on June 16 to perform a third‑party audit of medical claims processed by the county’s TPA, UMR, for the self‑insured health plan.
HR Director Gary Mlan explained the county has not previously commissioned a comprehensive claims audit and that switching TPAs revealed processing errors in prior years. Loomlight will build the plan in its platform, run recent claims through the model, and reconcile discrepancies through meetings with UMR. The firm estimated the work at about $29,650 and a timeframe of roughly six to ten months, dependent on data access and TPA cooperation.
Mlan said the audit could identify one‑off coding errors or systemic problems that merit plan design changes or recoveries; the county's self‑insured fund will cover the engagement cost. Commissioners approved proceeding with the master service agreement and statement of work.
What this means: The audit aims to increase transparency into claims adjudication, identify recoverable overpayments or misprocessing, and guide future decisions about plan design and TPA contracting.
