Dependent Audits DONE RIGHT: How?

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Tuesday, November 27, 2018 11:16:00 AM Categories: Tools of the Trade

A dependent eligibility audit, when DONE RIGHT, is not a burden on your workforce, and still generates a positive return on investment. In order to do a DEA the RIGHT way, the focus needs to be on the response rate.

Earlier this year, a number of articles came out questioning the merits of doing a Dependent Eligibility Audit (DEA), citing the not-so-successful audit done for the State of North Carolina.The problem was not in the audit itself, but in the fact that it clearly wasn't DONE RIGHT.

Many audit firms focus on removal rate, trying to find as many dependents as they can to "kick off the plan." The problem with this approach, however, is that your employees start to feel they're in a manhunt, instead of just participating in an enrollment survey. And when exceptions to the rule arise - as they do more and more in these days of non-conventional families - they aren't treated with respect, or aren't even addressed at all. This oversight will hurt employee relations. On the numbers side, if an audit isn't done with the goal of a high response rate, they won't find all the ineligibles, and some of the ineligibles they do find will actually be eligible, and come back in a costly appeals process.

The North Carolina audit is a good example of a job NOT DONE RIGHT:

"The way the office is collecting the information has some people fuming." The audit process needs to be flexible and adaptable enough to accept responses (including documentation) in a number of different ways. Not only should there be an online upload option, but enrollees should be able to securely fax or mail their documentation, or even bring them in to a physical location. In order to preserve positive employee relations, the audit process should makes things easy and convenient for the enrollees to comply, rather than build the process in the way that's easiest for the audit vendor.

"People who don't meet the deadline will have their families' coverage cut off." The North Carolina audit was executed on a relatively quick timeline. According to an audit announcement communication, the audit began May 22, 2017, and concluded on July 31, 2017, with termination on August 1 of anyone not verified. Audit firms that prioritize a high response rate will reach out a number of times, allow enrollees ample time to respond to each, and even build in a grace period after the final due date. This ensures that all eligible dependents, even those with extenuating circumstances, are able to be verified.

"Enrolled members can appeal if dependents who qualify lose coverage." Appeals shouldn't need to be part of the audit process. When an audit is done with the goal of a high response rate, enrollees don't have any grounds for appeal, as numerous attempts have been made to reach them, in various forms, and over a reasonable amount of time.

For a Dependent Eligibility Audit DONE RIGHT, contact us at Health Decisions. In the close to thirty years we've been doing these audits, we've averaged a 97% response rate, and never had an employee appeal.

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