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Quality Health Claims Consultants, LLC City of Joliet Dependent Verification Audit Proposal.

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Presentation on theme: "Quality Health Claims Consultants, LLC City of Joliet Dependent Verification Audit Proposal."— Presentation transcript:

1 Quality Health Claims Consultants, LLC City of Joliet Dependent Verification Audit Proposal

2 Who is QHCC, LLC ? Our Mission: QHCC is a consulting business that specializes in helping businesses and companies maximize their dollars spent on health care and insurance for their employees. What we do: We do this not by recommending that benefits be cut for any employees but rather by looking at existing benefits and ensuring that money is being spent efficiently. No employer should be paying more than they have to for benefits. In addition, spending money efficiently means that benefits for existing employees are much more likely to remain intact. ACCURACY EXPERTISE RESULTS

3 Dependent Verification One of the key ways of ensuring that health insurance benefits are functioning efficiently in the monetary sense is by making sure that all dependents covered under an employers plan are entitled to be covered. We can ensure this by conducting a Dependent Verification Audit. Easily Quantifiable results: Industry standards indicate that these audits uncover unqualified dependents at a rate of approximately 2 – 8%. For the City of Joliet this could represent a significant savings. Assuming 2075 dependents covered that could be 41 to 166 people currently being covered that shouldn’t be. Those savings have the potential to run into the 6 figures. ACCURACY EXPERTISE RESULTS

4 Be Benefits to the City of Joliet of an Audit Benefits to the City of Joliet of conducting an Audit include: It removes anyone not entitled to coverage Accuracy of numbers gives you a better bargaining position with your insurance carrier Ensures all employee records are up to date Helps determine the best rate structure moving forward Lessens claim exposure which keeps premiums down Unqualified Dependents might include children who have aged out, ex-spouses who have not been removed from the plan, children who are not legal dependents, and others. ACCURACY EXPERTISE RESULTS

5 The Dependent Verification Audit Process Process Overview: A QHCC Dependent Verification Audit is built to be flexible. We design each Audit with your specific needs and objectives in mind. The steps below outline our “best practice” approach. Our typical communication program includes the following: Amnesty Letter Verification Letter Reminder Letter Final Notice Letter Confirmation of receipt letter Notice of Potential termination letter Involuntary termination Letter ACCURACY EXPERTISE RESULTS

6 Th The Dependent Eligibility Audit Process Requested Documents may include: Marriage Certificate Front page of federal tax return (confidential Information removed) Current Utility Bill Birth / Adoption certificate Court Order to provide dependent cover All documents received will be scanned and stored securely until the completion of the audit at which time an electronic copy of all employee files will be provided to the City of Joliet. All physical documentation will be kept for a period of 6 months after which it will be destroyed and a certificate of destruction supplied to the City of Joliet. ACCURACY EXPERTISE RESULTS

7 QHCC Customer Service We are dedicated to the Success of your Audit One of the keys to a successful dependent verification audit is the employee customer service experience. Throughout the audit process your employees will be able to contact QHCC through a variety of ways. These include: Dedicated email 24/7 Dedicated call center open 8.00 am to 8.00pm Toll-free fax US mail All employees will be fully trained in the specific elements of your audit prior to taking any calls from your employees to ensure they have all the information necessary to provide your employees with the best experience possible. ACCURACY EXPERTISE RESULTS

8 QHCC Customer Service Financial Benefits and Rewards of an Audit Savings Calculation QHCC ’s Dependent Verification Audit produces substantial quantitative savings utilizing conservative assumptions. Assumptions Average annual cost per covered member $5,534 Number of Covered Dependents 2,075 Period of Financial return 1 year ACCURACY EXPERTISE RESULTS

9 Projected Potential Savings Conservative Calculation A 2% reduction in dependents:41 Annual savings for removed dependents$226,894 Moderate Calculation A 5% reduction in dependents104 Annual savings for removed dependents$575,536 Typical Calculation A 8% reduction in dependents166 Annual savings for removed dependents $918,644 In addition, removing these dependents reduces potential for paying up to $200,000 in claims, should an ineligible dependent incur a large loss claim. ACCURACY EXPERTISE RESULTS

10 QHCC Fee Structure QHCC Audit Fees : The City of Joliet has 912 employees who have dependent coverage. There are 2,075 dependents in total covered by those 912 employees. QHCC Flat fee: 2075 x $9.50 = $19,713 Advantage: We offer a flat fee so that the cost of the Audit is fixed and determined before commencement. There are no additional surprises or charges. Summation: With cost savings in excess of at least 11 times these amounts, a Dependent Verification Audit is not only necessary, it is affordable. ACCURACY EXPERTISE RESULTS

11 QHCC Customer Service Summation: Thank you for reviewing QHCC ’s proposal for your Dependent Verification Audit. We appreciate your time and the opportunity to earn your business. Should you have any questions QHCC can be contacted directly : Helen Franz 708 769 9291 helen@qualityhealthclaims.com Susan Cristelli 815 341 2135 susan@qualityhealthclaims.com ACCURACY EXPERTISE RESULTS


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