HDM's BenefitsAudit is a retrospective audit that utilizes 100% of the employer's claims data, specifically developed to assist the self-insured reduce the cost of their healthcare expenses, identify overpayments and subrogation issues, and discover opportunities for improvement based on benchmarking of industry best practices.
Features
Benefits Audit is a detailed look at the past performance of health plan administrators and pharmacy benefit managers. We assess contract and plan compliance, and identify performance issues that results in recovery of past overpayments and corrective actions that lead to future savings. The audit sets a performance baseline and creates an action plan to reduce costs and manage risks.
Data Warehouse
Integrates employer's multiple administrator databases of claims, eligibility, and benefits into a centralized standard data warehouse.
Business Rules Engine
Comparative logic created from each administrator's contract, Summary Plan Documents (SPDs), formulary, industry standards, and proprietary rules.
Exception Analysis
100% of claims and eligibility data is compared and analyzed to best business practices and administrator's procedures. Exception reports are generated with potential errors and issues identified.
Onsite Audit
Onsite audit performed to validate findings; operational review to assess business processes and internal controls; financial reconciliation to verify proper invoicing and banking.
Audit Reports
Audit findings, administrators responses, and recommendations for improvements and cost-savings.
Benefits
The detailed analysis and data mining performed by BenefitsAudit provides the employer with actionable information to meet Sarbanes-Oxley and other reporting requirements. Clear cut analysis resulting in monetary recoveries, and benchmarks provide a basis of understanding to negotiate more favorable agreements.
Additional benefits from BenefitsAudit include the following:
| . Enables employers to meet fiduciary responsibility |
| . Detects other party liability issues |
| . Establishes benchmarks for performance improvement |
| . Identifies contract changes for a improved return on investment |
| . No investment in staffing or technology is required |
Return On Investment
Using HDM's analytical services can provide a return on investment of 3:1 or better. To learn more about our cost containment solutions for self-insured employers, contact HDM today at 800.859.5119 or request information with our online form. You may also send an email to: info@HDMinc.com.
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