If you’re responsible for any aspect of your company’s employee health plan, you may accept the reality of health plan audits merely as a necessary evil in your life. But if you’re being really honest — with yourself, your direct reports, and the people up the ladder — you know health plan audits have the potential to do much more than you might think and have much greater value.
- They can help you ensure your company is getting its money’s worth from your carrier or third-party administrator (or discover that you’re not).
- They can certify that your employees’ claims are being processed accurately (or, again, that they’re not).
- Equally important, a properly conducted health plan audit will give you the confidence that you are meeting the standards for regulatory compliance and fiduciary responsibility (or they will illustrate gaps where you’re not).
That’s all great, right? But outside of auditors, carriers, and claims administration vendors, who in the heck really understands the world of health plan audits?
- Do you know what the different kinds are?
- Do you understand the goals the different kinds of health plan audits are meant to achieve — how they differ from one another, relate to each other, and even overlap?
- Do you know when you should consider having an outside auditor dive into your health plan’s policies and data to get the information you really need to save your company and employees money, ensure that all of the agreed-upon metrics for accuracy and performance guarantees are met, and meet your regulatory and financial commitments and obligations?
This e-book is a guide to four business situations when you could greatly benefit from a health plan audit — and what audits to consider and questions to ask when those times come.