APEX provides independent, statistically-valid assessments of the quality of the administrative services provided by Third Party Administrators or internal claims departments to sponsors of medical, dental, or prescription drug plans.

Our TPA Audit services include sample-based claim audits, electronic claim audits, claim office administrative operations reviews, computer system capabilities and controls review, financial audit, and drafting of administrative performance agreements. Our TPA claim audit staff are all full-time healthcare claim auditors with direct claims processing and auditing experience.

Our staff of claims professionals, based on many years of industry experience and using our sophisticated claim sampling technique, help clients assess the accuracy, efficiency, and timeliness of the work performed by claim paying entities.

This includes first dollar and self-funded programs as well as excess loss.