medical plan

BenefitsAudit

For a retrospective audit of health plan expense, no one offers a better, more comprehensive claims analysis than HDM. Unlike random-sample audits, which are commonly based on a limited claims sample, Benefits Audit is based on an analysis of 100 percent of the claims for the period...medical, dental or Rx claims, or all three. And unlike any company we know of that alleges to be doing 100-percent of-claims audits, HDM analyzes claims following a proprietary, five-step protocol.
The effectives of our 100-percent-of claims methodology was proven in an independent study that compared it to 100 simulations of random-sample audits. The random-sampling method consistently failed to identify 90 percent or more of the claim errors that HDM identified. See for yourself. Click here to download the study.
The two aims of the Audit are…

• To reduce the cost of employee health plan expenses, identify overpayments, claims errors, other-party liability and medical management issues, and discover opportunities for improvement based on benchmarking against industry best practices.
• To assure the accountability of Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) according to the Administrative Service Only (ASO) agreement and Summary Plan Description (SPD) that governs their relationship with an employer.

BenefitsAudit is a retrospective audit focused on the past performance of health plan administrators and pharmacy benefit managers. We assess contract and plan compliance, and identify performance issues that result in recovery of past overpayments and corrective actions that lead to future savings. The audit sets a performance baseline and creates an action plan to reduce costs and manage risks. The baseline can be used to transition to our BenefitsWatch service, which provides continuous monitoring of health plan expense.

BenefitsAudit is not Web-delivered. It requires no IT involvement in our client's organization, and no investment in new hires. We do the numbers crunching and provide the analysis. We go onsite to conduct claims audits and operational reviews.

The deliverable is a final report, including responses from administrators and HDM recommendations, based on the findings of the BenefitsAudit and HDM's expertise as the leading third-party provider of health benefit plan audits and analytics.