Enrollment Audits
Health Decisions and Dependent Eligibility Audits – Health Decisions has been a market leader in the auditing of health care plans for over twenty years. Since the early 1990’s, Health Decisions has been conducting exclusive Dependent Eligibility and Enrollment Verification Audits with a proven track record.
Dependent Eligibility Audits: Employers have been seeking ways to save medical plan expenses. An increasing number of employers are contracting with Health Decisions for Dependent Eligibility Audits. Our Dependent Eligibility Audits identify and remove ineligible dependents from employer medical plans. They deliver a solid ROI (Return on Investment) and provide accurate eligibility information that can be applied going foward.
Health Decisions offers a customized approach to meet each employer’s unique needs. Dependent Eligibility Audits conducted by Health Decisions entail a mailing to employees with a spouse and/or dependents enrolled in an employer’s health plan. The employee is then required to certify that all covered dependents are eligible for coverage.
Health Decisions combines its proven customized communications and mailing technology to request and successfully obtain information from employees. An eligibility database is created to record information and tabulate documents received. Health Decisions also offers a “call center” for employee inquiries. Reporting on project results is available on a daily basis if necessary. In order to close the communication loop at a project’s end, Health Decisions also offers optional “disposition” communications to employees.
Health Decision’s “unique” approach to a Dependent Eligibility Audit:
Health Decisions Dependent Eligibility Audits also feature:
Typical Questions that May Arise
How would my company benefit from a Health Decisions Dependent Eligibility Audit? Let’s take a sample employer with 2,500 employees. This group has an additional 1,250 enrolled dependents in their medical plan. Conservatively, let’s assume that 10% or 125 dependents are found to be “ineligible” based on the Health Decisions Dependent Eligibility Audit. At an approximate annual cost of $2,500 per claimed dependent, that’s an estimated savings of $312,500 to the employers self-funded medical plan.
Note, that the potential value of an audit lies within your dependent eligibility data, but just how accurate is that? If you are like the majority of employers, and don’t know, it makes perfect sense to conduct a thorough Dependent Eligibility Audit by Health Decisions.
What kind of ROI do employers typically acheive with a Dependent Eligibility Audit or similar type of Enrollment Verification Audit conducted by Health Decisions?
A typical employer would expect to acheive an ROI of $5.77 to $1.00. Determining factors include the size of your group in relation to its number of dependents versus the cost of the audit. Contact Si Nahra, President of Health Decisions to discuss your specific company situation contact Si directly: si@healthdecisions.com
Is it true that many employers offer an amnesty period to report ineligible dependent(s) without penalty?
Yes, it is true that many employers often allow an amnesty period at the onset to allow employees to remove known ineligibles without penalty. Based on comparative results, an amnesty period generally promotes a more favorable and timely response rate. Both factors contribute toward a more successful audit.
To What extent will my staff be required to be involved?
Health Decisions Dependent Eligibility Audits and Enrollment Verification Audits are essentially a “turn key” operation. Key management would likely be involved at the project onset to identify parameters and map out a timeline of project execution. Key management is later involved again when a report of findings is reviewed and discussed by senior Health Decisions personnel.
Health Decisions and Enrollment Verification Audits
Health Decisions, has been a recognized market leader in the consulting and health plan auditing industry for over twenty years. Client history over the years has shown that within the first quarter of a new calendar year is the key time to conduct an Enrollment Audit. This is especially true for employers that obtained limited to no information during their open enrollment process.
Enrollment Verification Audit & Survey The Enrollment Verification Audit begins with a customized pre-populated survey form detailing health plan enrollment information that is mailed to all employees. These surveys capture and identify new information including: ineligible members; address changes; and other insurance coverage. More accurate eligibility data is obtained to be applied to future claim administration.
Enrollment Audits- in this specific type of audit, Health Decisions utilizes an electronic comparison of an employer’s HR/payroll system information to an employer’s health plan eligibility information. These audits often identify significant gaps in eligibility information that result in retrospective and future savings in claim costs.
How do I begin the process?
Have your plan administrator or other responsible party contact Si Nahra, President of Health Decisions directly at si@healthdecisions.com