HDM offers the leading benefits audit for the self-insured employer:

Analyze 100% of Claims Data

HDM analysis 100% of claims data for a one to three year period to achieve thorough results. 

Onsite Claims Audit

HDM reviews claims onsite to validate errors. HDM follows Statement on Auditing Standards (SAS) Guidelines. 

Discount Audit

HDM reviews the discount arrangement the plan is entitled to through its contract.  The fulfillment of the contract requirements are tested as the result of a focused review. 

Onsite Process and Internal Control Audit

HDM will initiate a comprehensive onsite review at the TPA’s and PBM’s facility. The purpose is to audit the control environment and processes. HDM will determine if errors or irregularities have occurred or the likelihood of them occurring.

Test Performance Guarantees

HDM evaluates performance guarantees and determines the level of fulfillment of each performance commitment, including Financial Accuracy, Procedural Accuracy and Claims Processing Timeliness.

Contract Compliance Audit

HDM performs a compliance audit of vendor contracts.

Overpayments

HDM identifies, validates and recovers overpayments due to claims error, eligibility, provider coding or other party liability issues.  

HealthAudit Consists of Four Proprietary Audit Programs:

• Medical Plans

• Pharmacy Plans

• Dental Plans

• Hospital Bills