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Dependent Audits

 

We've been performing dependent audits since 2004 and can easily help you design a total solution that will meet your business goals AND be a good fit for your organization's culture.

 

Clients can benefit from our wide variety of technology-based and "low tech" solutions designed to meet every client need and budget.  Our communications templates can be quickly and easily modified as well.

 

Given the flexibility of our solutions, we can easily pair a working spouse audit or working spouse survey with your dependent audit which further increases your ROI!  

 

Clients really like our Dependent Information Verification Analyzer (DIVA) tool. Unlike web-based audits, employees only need a telephone with a dial tone to complete the audit. Given the nature of our phone-based audit, our survey tool is minimally-invasive and is designed to pass 80% plus of employees without having to submit supporting documentation.  HR really likes this since this improves governance AND maintains employee relations.

 

If you're very concerned about data privacy and identity theft and you will likely be interested in our on-site audits (not available at this time due to Covid-19).  Our trained on-site auditors simply review supporting documentation - we never take possession. Employees love this!

 

Since we offer these audits on either a fixed-fee, "success" or aggregate ROI guarantee basis clients can easily find the best way to fund their project.

Medical Claim Audits

 

Do you have assurance 100% of your medical claims are being paid consistently with your SPD and ASO contractual provisions?

 

Would you like answers to questions that you have not been able to get, such as "are our medical claims being paid by both the medical plan and the workers' compensation plan?

 

Would you like an independent and objective 3rd party to identify and correct costly financial leakage?

 

Do you have a specific concern that requires a "CSI-like" (forensic) approach?

 

If you answered "yes" to any of these questions than please contact us.  Unlike incumbent advisors that can be somewhat biased, as independent auditors we will "go to the mat" on your behalf and help you monetize past errors and identify root cause improvements.

 

Since we use 100% of your claims data, a bi-product of our audit is a dashboard replete with actionable analytics which at times, have a higher value than the audit findings.

ACA Administration

 

Would you like to outsource your 1094 and 1095 reporting?

 

Are you concerned that you're not properly identifying non-benefits eligible employees, such as part-time, variable hour or seasonal employees?

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Did you recently receive Letter 226-J from the IRS or would you like to audit your recipient and/or 1095-C offer of coverage as well as your employee status indicator codes?

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If you answered "yes" please contact us today to discuss our Employer Mandate, 1095-C Auditing and Letter 226-J Data Support solutions.

 

Working Spouse Audits

 

Would you like to make sure every employee that has a working spouse with other insurance is either 1) Paying their respective surcharge?, or 2) Has been carved-out?


Do you have 100% that all of your employees with working spouses understand your working spouse provision?

 

Do you think an outside, third party could identify more working spouses which will help your plan's financial position?

 

If you answered "yes" to any of these question, then please contact us to learn more about our suite of working spouse auditing solutions.

Working Spouse Surveys

 

Are you curious about how much money your plan can save if you implemented a working spouse provision?

 

Would you prefer to have empirical data about your employees BEFORE implementing a working spouse provision?

 

If you answered "yes" to either of these questions, the good news is our working spouse survey can be performed in a friendly and cost-effective manner as either a standalone survey or as part of a dependent audit.

 

Clients can choose to perform our working spouse survey either "snail mail," web-based or interactive voice response (i.e., automated telephone).

Pharmacy Audits

 

Do you have assurance 100% of your pharmacy claims are being paid consistently with your SPD and ASO contractual provisions?

 

Would you like assurance the conditions handled by your disease management programs mirror the pharmacy claims?

 

Are you concerned about broader enterprise risk due to high utilization of narcotics?

 

Would you like an independent and objective 3rd party to identify and correct costly financial leakage?

 

Do you have a specific concern that requires a "CSI-like" (forensic) approach?

 

If you answered "yes" to any of these questions than please contact us.  Unlike incumbent advisors that can be somewhat biased, as independent auditors we will "go to the mat" on your behalf and help you monetize past errors and identify root cause improvements.

 

Since we use 100% of your claims data, a bi-product of our audit is a dashboard replete with actionable analytics which at times, have a higher value than the audit findings.

 

Analytics/Dashboards

 

As the expression goes, "information is power!"  This begs the question - Do you have the power you need to drive the right plan design changes?  Contribution strategy? Carrier negotiations?  Human capital strategy? Other? Or, at a much more basic level would you simply like to better understand the utilization and cost drivers of your plan?  Or, perhaps you have a BIGGER question regarding employee engagement.

 

Our Tableau dashboard (perhaps the most powerful data visualization tool in the Technology industry) enables clients to learn and discover so much more than any carrier reporting system. Moreover, when your claims data is paired with other important data, such as telemedicine utilization, wellness, pricing transparency, workers' compensation, disability or any other human capital dataset, your data really begins to tell the story.  It helps you make really great discoveries!

 

If you're thinking, wow, sounds good, but "how do I get this data?" here's the answer.  Since your self-insured plan has the right to review and analyze its claims data, carriers must provide your claims data to you when it's requested.  No ands,ifs or buts!  Analytics projects can either be performed based on a snapshot in time or can be refreshed on a monthly or quarterly basis.

 

We will be happy to demo our system at your convenience.

Specialty Audits

 

Let's face it.  There are a LOT of moving parts in the healthcare benefits ecosystem.  Each one of these moving parts is complex.  Given their respective complexities the possible error rate is high.  And error rates translate into plan savings which could be used to fund other HR or Benefits initiatives.

 

Examples of our Specialty audits include:

 

  • Employee Eligibility

  • Stop Loss

  • Wellness

  • Disease Management

  • Case Management

  • Workers' Compensation

  • Subrogation

  • Disabiilty

  • Death & Address Audits (Pensions)

 

If you have any questions regarding how any of these plans (or any parts of these plans) are performing, please contact us today.

Communications Software

 

Would you like to increase the utilization of benefit tools and features, such as telemedicine, pricing transparency, reference-based pricing, generics, mail order pharmacy or HSA plans?  Does the idea of frequent, targeted communications sound more effective than infrequent, one-size-fits-all messaging?

 

If you answered "yes" please contact us. Coolifi, our communications software engine lets users create better employee lists simply by clicking on demographic and claims data variables.

High Deductible Plan Analysis

 

Would you like to realize the savings associated with a HDHP, but you also want to "soften the financial impact" on employees?

 

We employ a 2-step process.  Step 1 - analyze 100% of your claims data to better understand exactly how your plan is being utilized.  Step 2 - Identify gap insurance plans and model various scenarios to make sure both the plan's and the employees' needs are being met.

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