HDM's BenefitsAudit provides an extensive review of employer health plan expenses and administration by third-party administrators and pharmacy benefit managers. HDM utilizes electronic analysis and sophisticate data mining to determine whether administrators are accurately adhering to contractual obligations, benefit plan designs and financial agreements with providers. The following is the method of BenefitsAudit.

Analyze 100% of Claims Data
Analysis of 100% of past performance of health benefits payments, including medical, pharmacy, and dental plan claims data, from a one- to three-year period to achieve maximum results.

Onsite Claims Audit
Onsite review of claims to validate errors and in accordance with the Statement on Auditing Standards (SAS) Guidelines.

Discount Audit
Evaluation of contractual discounts per individual provider contract arrangements. HDM verifies employers entitlement with the contract requirements tested as the result of specific provider contract reviews.

Onsite Process and Internal Control Audit
Comprehensive onsite audit of the control environment and processes at the TPA's and PBM's facility to determine compliance with HIPAA and Sarbanes-Oxley requirements. HDM's onsite analysis detects if errors or irregularities have occurred.

Test Performance Guarantees
Evaluate performance guarantees and determines the level of fulfillment of each commitment, including financial accuracy, procedural accuracy, and claims processing timeliness.

Contract Compliance Audit
Compliance audit of vendor contracts in accordance with Sarbanes-Oxley and industry standards.

Overpayments
Identifies and recovers overpayments for due to claims processing errors, eligibility, provider coding or subrogation issues.

Completion of the BenefitsAudit process sets a foundation with reliable metrics for ongoing monitoring of healthcare expenditures through the use of HDM's BenefitsWatch.

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.