Please call Health Decisions at 1-800-589-2500 or send an email to enrollments@healthdecisions.com.

Please send Requests for Proposals to Leslie Wilkins at leslie@healthdecisions.com.

Yes. Health Decisions, Inc. is fully HITECH and HIPAA compliant.  Our company is regulated by the HIPAA Privacy and Security rules as a Business Associate and all employees fully understand the sensitive nature of the information associated with each project. As a result, all employees are fully trained in the rules. Any and all files containing sensitive documentation are kept in a separate, HIPAA-secure environment, which is locked and only accessible to those employees working on the project.

Our Dependent Eligibility Audits find 6% of dependents to be ineligible, on average. However, the more important statistic that we focus on is response rate. Health Decisions is extremely proud of our overall 97% average response rate. And we are pleased to offer a response rate guarantee on every Dependent Eligibility Audit project, regardless of group size.

We operate during regular business hours, 9:00 am to 5:00 pm EST, Monday through Friday, with extended Call Center hours on a case by case basis. Every call to the Call Center is answered in less than five (5) rings. Messages left after hours are returned within the next business day.

Yes. Our in-house Call Center representatives handle calls in Spanish, and other calls are translated through utilization of Language Line services that provide live translation. We also offer a fully bilingual audit, including all communications translated into Spanish.

Health Decisions’ Dependent Eligibility Audit typically spans a 4 month period. The timeline for each project is customized according to the client’s goals.

Health Decisions does not perform audits based on a percentage of savings, as it is not in the best interest of our clients. Vendors who charge a fee based on the number of dependents removed generally do not achieve a high response rate; non-respondents are deemed to be ineligible, and then companies have to deal with costly appeals. Meanwhile, Health Decisions has never had an employee appeal as a result of our audits.

Health Decisions’ client-authorized collections can reduce claim costs 1-3% per year. For groups with more than 1,000 employees, this almost always generates a positive ROI. In addition to the opportunity for economic return, our audits help self-funded health plan fiduciaries to fulfill their legal and managerial obligations in assuring that all plan expenditures are warranted and that plan assets are not misspent.

The Health Decisions audit screens 100% of claims, enrollment, and relevant administrative data. A full range of investigative techniques are used to both confirm correct payment and identify overpayments and underpayments.

The Comprehensive Medical Claims Audit spans a 3-4 month period. Collection activity will follow for up to six months after audit completion

Health Decisions can include an on-site component to the review but this is not required. If requested by the client, or required by the payer and approved by the client, we will send audit staff on-site for an additional fee.

Health Decisions has audited more than 80 different payers, including Aetna, Cigna, United, most Blue Cross Blue Shield plans, and a number of TPAs.

Health Decisions does not perform audits based on contingency fees only, as it is not in the best interest of our clients. We recommend having audits performed on a fixed fee basis. Our audits review 100% of claims, while most contingency-based audits only look at high-dollar cases. In addition, with our audits, the client has the option to pursue collection and recovery on a case-by-case basis, and there are always some cases they will choose not to pursue. Contingency audits will not give the client that option, as they’ll need to pursue every recovery opportunity, even when an employee may be back-billed as a result. Finally, and perhaps most importantly, our audits include comprehensive reporting with recommendations for management and suggestions on how to correct system and administrative processes to prevent costly errors from continuing to happen; contingency audits rarely offer reporting, and will not recommend corrective measures, as they are paid more if those same erroneous processes continue to happen.