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.
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
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.