FAQs

• Does BenefitsAudit have to be simultaneously applied to medical, dental and prescription drug plans?
  No. BenefitsAudit can be used to analyze your medical, dental, or prescription drug plan or all three.
  
• What are the essential differences between BenefitsAudit and your other main service, BenefitsWatch?
  There are four essential differences:
  
  1) BenefitsAudit is a retrospective audit that requires one data download from your Third Party Administrator (TPA) and/or Pharmacy Benefits Manager (PBM) and only addresses whether or not your plan administrators are in compliance with the ASO and SPD they’ve agreed to with you. BenefitsWatch analyzes claims concurrently, practically as they are paid. The service provides continuous monitoring that requires a data feed, and not only identifies compliance errors and fraud, but looks at two other critical areas of plan performance – financial management and cost and utilization.
  
  2) With BenefitsAudit, savings can be realized and corrective taken year-to-year. With BenefitsWatch, savings are realized and corrective action can be taken quarter-to-quarter.
  
  3) With BenefitsAudit, the deliverable is one report, accompanied by recommendations and consultation. With BenefitsWatch, the deliverable is quarterly reports, recommendations and consultation…continuous monitoring for the life of the contract, usually two to three years.
  
  4) BenefitsAudit can be utilized for a medical, dental, or prescription drug plans or for all three. BenefitsWatch requires both medical and prescription drug data in order to deliver maximum savings and value to the client. Dental data can also be included. For continuous monitoring of health plan expense, learn more about BenefitsWatch.
  
  There is one common element to BenefitsWatch and BenefitsAudit...our unique five-step protocol that analyzes 100-percent of claims for the audit period. HDM’s protocol has been proven in an independent study to be far superior to random sampling. To find out more, click here to download the study.
  
  
• How do we get started with BenefitsAudit?
  You review and execute a service agreement. We then assign you to a BenefitsAudit Account Manager, who will work with you to assure the efficient exchange of data from your administrators. We do the rest.
  
  
• How long does it take to get up and running with BenefitsAudit?
  Normally, about 30 to 45 days.
  
  
• I’m not sure that our administrators will cooperate with 100 percent of their data. Will they?
  By contract, they have to. In our nearly two decades in business, we’ve audited most of the TPAs and PBMs in America. We’re familiar with their data and they are comfortable with us.
  
  
• How do you assure the integrity of the data you’ll take in from our administrators?
  Our in-depth knowledge of administrator systems assures the efficient exchange of data. We have exchanged data with most administrators in the U. S. at least once.
  
  
• How can we be sure of your objectivity?
  We are a totally objective third party. Although we have audited most major TPAs and PBMs in America, we have no relationships with these types of organization. Our allegiance is to our clients…the organizations that call upon us to analyze plan performance.
  
  
• Will we have to hire one or more people to interface with HDM?
  No. You simply have to designate who in your company should be the point person, and who should receive the final BenefitsAudit report.
  
  
• Who then needs to be involved at our end?
  This depends on who is spearheading the audit within your organization…Benefits, Finance or your Internal Audit Department. We always strive to have Benefits involved to provide plan information.
  
  
• Will BenefitsAudit work enterprise-wide? Can we compare health plan performance by company or division?
  With BenefitsAudit, we audit by plan type – which may not correspond to business unit. Large companies have various plan types (EG a PPO and an HMO) and employees from across business units select the plan they want, so an HMO may include employees from multiple business units. The more relevant analysis with BenefitsAudit is by type of member, such as active vs. retired and hourly vs. salaried…since different types of members tend to have different plans. If you want to also impact the two other critical areas of health plan performance – financial management and cost and utilization – and compare these two critical areas by business unit, you should learn more about BenefitsWatch, our service for continuously monitoring health plan expense.
  
  
• Will you help us interpret the final report?
  Count on it. We’re the leader in employee health benefit plan audits and analytics. Our experience and recommendations are part of the package.
  
  
• Who will be responsible for our account?
  We’ll assign your account to an HDM audit team. Your Account Manager will be your primary contact. Your Project Manager will handle to day-to-day workflow and correspondence, including project status reports. You may have direct access to every team member, including your analyst, if you like.
  
  
• Are you going to be able to consistently deliver savings year after year?
  Yes. Plans are dynamic. Employees come and go. Plan governance is an on-going process. With BenefitsAudit, when you measure plan performance year-to-year, you’ll consistently find that your plan isn’t performing to goals or to benchmarks in one area or another. With BenefitsWatch, you can continuously monitor plan performance quarter-to-quarter, and realize even more efficiencies and savings.
  
  
• Is there any limit to the size of the health plan BenefitsAudit can monitor?
  No. HDM clients range from small groups up to the largest employers in America.
  

To discuss how HDM’s cost containment solutions for self-insured employers can benefit
your organization, contact HDM today at 800.859.5119 ext. 1 or e-mail your inquiry to: info@HDMinc.com.