Medical, Prescription Drug and Related Plans Audit Services
Health care related costs typically represent more than 10% of payroll costs. Human Resource departments are stretched too thin and do not have the time to closely track the claims they are paying in their health and Rx Plans.
Your organization could be paying for claims that you are not responsible for. You could be inappropriately paying for claims by former employees that are no longer eligible, employees from other companies that were keypunched into your carrier’s system incorrectly, employees that have not yet met the eligibility rules and many other reasons.
Health care costs continue to rise dramatically. Concerned employers are searching for ways to keep costs down. One approach to controlling costs is auditing your health care claims and bills at least once a year.
Boomershine Consulting Group has the expertise and experience to complete claims audits including the following:
- Complete audit of Medical, Dental, Vision and Prescription Drug Plans for actives and retirees (where applicable)
- Determine eligibility for participants in all Medical, Dental, Vision and Prescription Drug Plans based on plan provisions
- Perform audit of all Medical plans for all participants (match eligible participants with the actual claims paid)
- Provide your organization with an executive summary of the results of the audit
- Work with you and your carriers to correct issues
- Create processes so that errors are minimized in the future
- Work with carriers to refund to you any claims paid in error
We can also complete audits for your group insurance plans, including Life Insurance, Long Term and Short Term Disability plans.
Employees incorrectly included in your plan’s coverages are not only costing you money today but will also cost you money in the future. The sooner they are removed from coverage the more you save.