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Case Study: Healthcare Expense Management, Audits and Contract Compliance for a State Government

Case Study: Healthcare Expense Management, Audits and Contract Compliance for a State Government

We perform independent, unbiased audits of your health plan expenses to save you money, and keep your TPA compliant with contractual provisions and financial standards.

Client Need

Benefits Plus Consulting Group, Inc. was retained, as a subcontractor, by a large prime on a five-year Medical Plan Audit contract for a large east coast state. The plan serves approximately 165,000 members. The State required independent audits of ten administrators that managed their self-insured medical, prescription drug, dental, mental health and flex-spending programs, in order to ensure compliance with contractual provisions and help to claim any cost recoveries for substandard performance.

The Benefits Plus Consulting Solutions

  • Performed on-site audits to monitor administrator compliance with performance guarantees for each contract fiscal year.
  • Coordinated a highly qualified, Maryland-based clinical team to perform on-site audits of case and disease management programs.
  • Drafted reports of the above for the prime to integrate with their claims, eligibility and benefits-data analysis.
  • Participated in annual meetings with the State’s fiduciaries and ten administrators to review and agree to findings and cost recoveries.
  • Resolved any discrepancies in order to issue final reports.

Results

The Benefits Plus Consulting Team continued to perform this work for one full five-year contract term, despite two acquisitions of the primes involved, and was retained again for the second five-year term.

Case studies presented are not indicative of all client experience with Benefits Plus Consulting Group, Inc. Each client has unique circumstances and the case studies presented are only meant to illustrate common issues encountered by our clients and the methodology we follow. Case studies presented should not be interpreted as a guarantee of future success.

Realize Your Resources Call Benefits Plus Consulting at 215-732-PLUS (7587)
A trusted, unbiased adviser for benefits, retirement and financial planning

BENEFITS PLUS CONSULTING GROUP, INC.
Serving the Northeast since 1993

1807 Pine Street
Philadelphia, PA 19103
Tel: 215-732-PLUS (7587)
Fax: 215-564-0286

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