Event Audit

If you’re changing claims administrators or making adjustments to your plan designs, it’s critical to test the accuracy and readiness of your claims administrator before your go-live date.

Pre-Implementation Audit
To ensure your administrator is ready to process your benefits, we take a number of critical pre-implementation steps, including:

  • Testing your administrator’s interpretation of your benefits against your Summary Plan Description provisions
  • Providing an action plan and timeline for resolving any issues
  • Serving as the liaison between you and your administrator to clarify plan design discrepancies and direct corrections, as needed


Post-Implementation Audit
As beneficial as pre-implementation audits can be, they do have limitations. They are performed in a claims-system test environment and the scope of what is reviewed is restricted by the number and thoroughness of the scenarios presented. That’s why we often recommend that a 100-percent, post-implementation audit be performed 90 days following the effective date of a material change. Our experience has found this to be an even more rigorous and complete approach to testing benefits interpretation and setup.

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 Two Minutes to Claims Auditing
Marie Bowker, Senior Director of Practice Leadership

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Jean MacQuarrie, Vice President, Payment Integrity Solutions