Benefits Auditing from Secova is the fastest way to begin saving money by analyzing your benefits plan as well as auditing proper usage by employees and medical professionals alike.
Benefits Auditing includes:
Secova has the expertise and the resources to run these audits so that you don't have to. The savings in time and money can be significant and can be realized relatively quickly.
Benefit Program Audit
The Benefit Program Audit provides a review of your total benefit program and detailed financial data that will help identify budget issues and identify program changes when necessary.
The Benefit Program Audit includes:
- Program performance against projections
- Program performance against market
- Evaluation of the program on service and quality of care, as defined by employees and industry standards
- Overall financial impact analysis
Secova's Benefit Program Audit will assist you when it is time to negotiate benefits for the new season by helping you understand trends in competitive companies and in the industry as a whole.
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Dependent Eligibility Audit
Dependent Audits are conducted to ensure that only qualified dependents of employees receive benefits by meeting predefined eligibility rules. Secova takes on the task of communicating with your employees to verify the eligibility of their dependents.
The Dependent Eligibility Audit includes:
- Employee and dependent communications
- Communication follow-up and data verification
- Termination and coordination of non-eligible dependents
- Ongoing dependent eligibility analysis
By identifying and removing non-eligible dependents with this process, The Dependent Eligibility Audit saves administrative costs, prevents filing of erroneous claims, and improves the renewal process by ensuring that accurate demographic data is used to determine plan pricing.
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Medical Claims Audit
Secova gathers your claims data to analyze all medical claims from a specified period. (This applies to both self-insured and fully insured services.) Using this information, Secova identifies erroneous claims, documents the findings, and recovers funds when applicable.
The Medical Claims Audit includes:
- Procedure and hospital bill audit
- Diagnosis related group (DRG) validation
- Cost-based review
- Refund recovery
- Subrogation
- Issues and resolution analysis
Verifying medical claims is a time-consuming and costly exercise that requires special skills and resources. Secova has the data mining tools and experienced audit professionals to conduct an in depth review of your medical claims to resolve any issues - including the recovery of funds when appropriate.
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Many of Secova's clients use the detailed results of these audits to modify their existing plans to reach an even greater ROI. In addition, with the option of implementing our Best Shore strategy we are able to further shape each solution based on your financial goals, utilizing each of our locations to deliver the solution that provides the best value, both in quality and cost - a new approach for the mid-to large market companies looking to streamline their HR and Benefits Management operations.
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