Benefit and Care Plan Audits

Organizations are facing the ever-increasing challenges of ensuring health plan compliance and controlling overall benefit costs — without actually reducing the benefits offered.

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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:

Eligibility

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.

Claims

  • Medical
    • 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.

Care Management

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

WE PROVIDE CONSULTING SERVICES. WE DO NOT PROVIDE LEGAL SERVICES, TAX SERVICES NOR OTHERWISE ENGAGE IN THE PRACTICE OF LAW.