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 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.
MedBill Management has one of the highest employee response rates in the industry, achieving an average 99.7% 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.
The number one complaint of organizations who have used other dependent audit vendors is that the projects end with letters going out to 5-20% of the plan participants telling them that their dependents’ coverage has been terminated because they did not respond to the project. When this occurs it results in a lot of extra work for the Human Resources/Benefits Team who must deal with the employee relations issues, coverage reinstatements, grievances, etc. MedBill Management feels very strongly that if the job is done right, and sufficient follow-up occurs, then all participants will respond. This results in a complete collection of eligibility-related documentation, no burden on the HR/Benefits Team, positive employee relations and a true measure of actual ineligible dependents.
Most employers have collected some dependent eligibility documentation in the past. The big question is whether or not an organization is confident that it has updated records for all currently covered dependents and that those eligibility-related documents are sufficient proof of current eligibility. For example, if a marriage certificate was collected as proof of spousal eligibility five years ago, what happens if the employee is now divorced? Every Dependent Eligibility Verification project performed by MedBill Management has identified ineligible dependents participating in the plan, even with the most stringent documentation requirements – and we are willing to guarantee a successful financial outcome.
MedBill Management takes system security, privacy, and document storage very seriously. MedBill Management has implemented technology, security features and strict policy guidelines to safeguard the privacy of individually identifiable information from unauthorized access or improper use. These policies include, but are not limited to; double-secured physical storage, use of secured servers with advanced encryption and restricted access to all files and documents.
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.
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.
It is critical that the dependent audit vendor 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 of these critical success factors 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.