Dependent Eligibility Audits

As healthcare costs continue to escalate, HDM's Dependent Eligibility Audit is an invaluable service for effectively qualifying the eligibility and benefits of employee dependents. By identifying and removing ineligible dependents with this auditing process, the Dependent Eligibility Audit accomplishes three purposes:

• It saves employers an average of $3,250 per ineligible dependent removed from the plan (based on one year of expenses).
• It prevents filing of erroneous claims.
• It improves the renewal process by ensuring that accurate demographic data is utilized to determine correct dependent eligibility.

The Audit can be used to review an employer's entire dependent population or to target specific high-risk groups.

Process
Amnesty Period
The amnesty period is an important tool in our dependent eligibility audit, because it effectively identifies and removes ineligible dependents from an employer's self-funded health plan. During the amnesty period, employees are requested to self-report any dependents who are enrolled in the health plan, and who are not meeting the plan's eligibility requirements. Typically, there are no financial consequences for employees who self-report their ineligible dependents relative to past paid claims during the amnesty period.

Data Collection and Electronic Analysis
HDM obtains an employee/dependent eligibility data file from your Third-Party Administrator (TPA).  This file contains detailed enrollment records for all employees who currently have dependents enrolled.
HDM imports and analyzes eligibility using customized applications we developed.  We then mine the data and categorize dependents based on various parameters, in order to tailor document request letters.

Document Requests
We send document requests to all employees (or a sub-set of employees) with enrolled dependents.

Documentation Collection and Eligibility Confirmation
HDM prepares the document request letters that are sent to employees. Employee responses and all related documents are returned by the employee directly to HDM. We then monitor responses, send a follow-up letter to non-respondents, and review all submitted documents in order to identify those who not meet the plan's requirements and confirm eligible dependents.

Call Center
HDM can provide a call center for inbound calls and employee questions, as well as an outbound call center to reach employees who have not responded to the request.

Value Delivered
Our Dependent Eligibility Audit typically uncovers significant numbers of ineligible dependents, as well as aged-out college students and divorced spouses, which often results in considerable savings in annual health care costs for employers.

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.