Employers continue to see increases in the cost of their health care benefit programs. In an effort to manage those costs, many have elected to self-insure, calling on third-party administrators or insurers to administer benefits and process medical claims. To help you monitor costs and track the performance of your benefit plans, we offer services in two key areas.

Claims Performance Reviews 

More often than not, annual health care claims constitute an organization’s highest unaudited expense. Are you confident your administrator is paying only the bills that should be paid—and paying them correctly? If not, verifying this will not only fulfill your fiduciary responsibility as a plan sponsor but also help you evaluate whether your claims are being paid accurately and in accordance with the plan’s intended provisions.

Our approach incorporates a strategic plan customized to your organization’s needs, collaboration with key stakeholders to identify vital issues, and a personalized report summarizing accuracy results and identifying risk areas and potential administrative and interpretive issues with the plan benefit administrator.

After we conduct a claims performance review, you can:

• Identify claims payment errors and recover identified overpayments
• Improve administrative performance by identifying and correcting systemic issues
• Use the results as a benchmark for establishing or renegotiating performance guarantees with your plan administrator
• Avoid costly penalties by improving compliance with contracts and procedures
• Identify exceptions to standard cost control procedures

Dependent Eligibility Audits

In the era of health care reform, it’s more important than ever for employers to ensure that dependents enrolled on their sponsored benefit plans meet the eligibility guidelines. As a result, dependent eligibility verification audits are an increasingly important tool to help protect your company’s financial interests.

We inspect your health and welfare plan to see that all enrolled as dependents are eligible per plan rules, with the goals of reducing future costs and maintaining compliance.