Frequently Asked Questions
Why should an organization consider doing a Dependent Eligibility Verification Project?
It is important that employers exercise their fiduciary right to control benefit costs by ensuring that the plan is only paying for eligible claims costs from eligible plan participants. Although the vast majority of enrolled dependents are typically eligible to participate, every plan is covering dependents who do not meet the plan’s eligibility requirements.
Increasingly complex family structures have made it much more difficult to manage health plan eligibility. Benefit plan managers are now faced with constantly changing family demographics – divorces, step-families, guardianships, custodianships, etc. As a result, Dependent Eligibility Verification is no longer an optional service, it is a critical component of managing compliance and controlling costs for all health plans.
In addition to eliminating unnecessary plan expenses, validating the eligibility of covered dependents will help to eliminate an organization’s exposure to potentially catastrophic claims. Most organizations manage their risk by purchasing Stop Loss insurance coverage to mitigate the impact of high cost claims. If a covered dependent is a high cost claimant, and it is discovered that the person does not meet the plan’s eligibility requirements, then the Stop Loss insurance carrier will quickly deny reimbursement for the entire case.
Does MedBill Management receive the eligibility-related documentation for all covered dependents, or do many of them opt-out?
MedBill Management has one of the highest employee response rates in the industry, achieving an average 99.4% across all Clients, and has never had an employee appeal. MedBill Management’s nearly perfect response rate is the result of our customized communications, unlimited outbound calls and extensive follow-up to secure responses and dependent-related documentation from all plan participants. Our customer service team also takes the extra time to work with employees who have unusual circumstances to help them identify, and obtain, the appropriate documentation.
Why is it important to have a high project response rate?
Is there any benefit to conducting a Dependent Eligibility Verification Project if we have collected dependent-related documentation from employees in the past?
How are documents and data protected?
MedBill Management maintains an in depth security policy that describes all necessary procedures to maintain a high level of ongoing security, including password policies, security log procedures, and network security administrators who review and approve all of the above information. Application users are only provided access to data on an as-needed basis to perform the functions related to their position.
What are the keys to a successful dependent eligibility verification project?
The first step in any successful Dependent Eligibility Verification Project is to develop a comprehensive plan including a timeline that works well for your employees, does not interfere with your organization’s objectives and won’t conflict with other employee benefit initiatives. The plan should include a clear, customized, employee-friendly communication strategy. The communication pieces and the strategy should be shared, in advance, with key managers, employee representatives, union leaders, etc. Successful projects all start with “buy-in” from the key constituents.
Once the project begins, the dependent audit vendor must handle employee questions professionally, consistently and with compassion. Employees want to discuss their unique, and sometimes sensitive, family situations with real people, not machines.
The dependent audit vendor must have a clearly articulated strategy, and adequate resources, to ensure that an employee response rate of very close to 100% is achieved. The importance of this cannot be overstated.
If each critical success factor is achieved by your Dependent Eligibility Verification partner then the project will almost always be successful – by reducing unnecessary plan expenses, while maintaining positive employee relations.
Dependent Eligibility Verification
Learn more about this critical component of managing compliance and controlling costs for all of your health plans.