We are the only firm in America offering a full range of dependent eligibility auditing services. Whether you’re looking to: build a business case for performing a dependent audit, plan on performing a dependent audit for the first time, seeking to quantify the results from a recently performed dependent audit or want to make sure confirmed ineligibles aren’t receiving costly health benefits, we are the firm that does it all!
In addition, we also offer social security number validation (for dependents as well as employees) and coordination of benefits data capture vis-à-vis our dependent audit services.
More about our services follow:
1) Pre-Audit Analytics – Pre-Audit Analytics helps “skeptical” clients understand the financial opportunity prior to actually conducting a dependent eligibility audit. In essence, HR Best Practices identifies high dollar suspects based upon plan consumption as well as demographic anomalies, such as children with overlapping birthdays or spouses greater than 15 years apart. The main deliverable is a rigorous ROI-based business case that management can use to make a “go/no go” decision.
2) Concurrent ROI – Concurrent ROI shows clients actual, claims-based savings as the audit is being conducted. In order to do this, the claims data would be provided to HR Best Practices (this is routine for us) and the medical and prescription drug claims for each confirmed ineligible would be calculated. The main advantage of a claims-enabled dependent audit is the objectivity of the savings that a plan would be “book as real savings.” Please note that employers have the option of either outsourcing the call center services to us or can have their own internal call centers take calls from members.
3) Post-Audit ROI – Post-Audit ROI helps clients understand the savings after the dependent eligibility audit is completed. While the best time to do this is immediately following a project, it would be done within 4 months of completion. The main deliverable is a rigorous ROI-based business case that management can use for budgeting purposes.
4) Post-Audit Governance – Post-Audit Governance is a recurring service (at a minimum, 3 months) where medical and pharmacy claims data is compared to the confirmed ineligible list. This service provides additional assurance that “ineligibles” are not creeping back into the payor’s eligibility files.
As you can see, we are flexible and are happy to create a custom, high ROI solution for your plan. In the interim, please read the Business Week November 26, 2007 issue to learn more about our unique, yet practical approach to conducting dependent eligibility audits.
