A benefit plan audit can determine if claims are being administered accurately and eligible dependents are correctly covered according to the guidelines of your plan.
Our benefit plan audits include:
Dependent Eligibility Verification: Through a series of communications and required action items that guide employees through the dependent verification process, we can help your organization identify ineligible dependents and remove them from your benefit plans.
- Our traditional Stratified audit methodology provides statistically valid results, inferring administrator financial and procedural performance accuracy.
- Our Interactive Qualification (iQ) audit methodology, delivered through our proprietary software, evaluates 100% of claim data and identifies the areas of greatest potential financial risk.
- Rx: Using our iQ audit methodology, we analyze 100% of claim data for administrative, regulatory, plan guidelines, and contractual parameters, such as discount guarantees.
Clinical Care Management and Operations Audit: Utilization and case management programs are designed to ensure that the medical services meet accepted clinical criteria for coverage under the plan. The audit includes a review of processes designed to assess not only the program structure, but also program execution and the clinic’s subsequent impact on health and financial outcomes.
Health and Productivity Services
- Absence Management Services
- Benefit and Care Plan Audits
- Engagement and Portal Strategies
- Exchange Strategies and Solutions
- Federal and State Regulatory Compliance
- H&W Brokerage Services
- Health Analytics
- Health Care Supply Chain Management
- Health Strategy and Financial Management
- Pharmacy Plan Consulting
- Post-Retirement Medical Valuations
- Voluntary Benefits