Health and welfare audits
Buck’s audit practice provides focused audits and solutions to ensure claims are being administered accurately and according to the guidelines of the plan.
COBRA compliance audits: COBRA audits help organizations confirm that only eligible individuals are extended COBRA, that they pay the appropriate premium, and that their coverage ends at the appropriate time. A COBRA audit can help organizations avoid significant penalties, confirm compliance with requirements and HIPPA, and identify any issues with vendor performance.
Dependent eligibility verifications (DEV): Employers are finding it increasingly difficult to provide employees with a quality health plan at a reasonable cost. DEVs are one way to effectively reduce immediate and ongoing plan expenses. The concept is simple: through a series of communications and required action items that guide employees through the dependent validation process, Buck‘s DEVs identify ineligible dependents and remove them from your benefit plans. The process is quick, can provide a significant return-on-investment, and helps build an accurate foundation for your future health care benefits planning, claims auditing, and budgeting needs.
Take a moment to learn how we helped a client reduce its health care costs and plan expenses through a dependent eligibility verification.
Medical claim audits: One of health care’s greatest challenges is cost management. The process for managing costs needs to be flexible and accommodate each organization’s financial and fiduciary responsibilities.
Buck offers two types of audit methodologies designed to identify potential financial risk and confirm plan performance. Both will serve to satisfy certain fiduciary responsibilities required of all plan sponsors.
- The focused methodology starts with an electronic review of the entire claims data file using Buck’s proprietary software system. An Electronic Risk Assessment (ERA) provides both utilization and investigation information. Through interactive qualification with each administrator, Buck’s audit team maximizes the return-on-investment for each project or provides assurance that the plan is properly and accurately administered.
- For those who simply require an evaluation and confirmation of performance guarantees, we offer stratified and random methodologies.
Pharmacy claims audits: A pharmacy claims audit is part of ongoing due diligence and prudent management of an employee pharmacy benefit program. A pharmacy claims audit will ensure that a client’s pharmacy benefit manager (PBM) is performing its duties in accordance with the contractual obligations that govern pharmacy claims payments. We recommend using our focused audit approach, a two-step process that begins with a 100% electronic review of all paid claims and ends with an extensive review of any specific claim issues. Our interactive qualification with each PBM allows Buck’s audit team to maximize the return-on-investment or provide the assurance that the plan is properly and accurately administered.
Compliance audits: Laws and regulations impacting benefit and HR practices are becoming increasingly complex. Employers need to be aware of regulatory changes that affect their benefit plans — a once-compliant plan or program may no longer be in compliance. Buck’s compliance audits can be as narrow or as broad as the client’s needs dictate. A narrow review might involve simply examining plan documentation and written administrative procedures. An expanded review might also include evaluating actual administrative practices.
Health care management audits: Health care management programs often include utilization review, pre-certification, and case and disease management services, and are designed to ensure your employees and their families get the right care, at the right time, in the most effective and efficient way. A health care management audit can quickly identify your program’s operational strengths, weaknesses, and overall quality while also evaluating the program’s ability to positively impact clinical and financial outcomes for your employees.
Take a moment to learn how United Health Services used our auditing services to compare the medical management performance of their two current health plans and evaluate their vendors' performance.