Why does your organization need a performance

 

Every health plan sponsor faces issues of compliance, fiduciary responsibility and, of course, annual budgetary requirements. When administrative issues cause claims and compliance penalties to balloon unnecessarily, the cost can be astronomical.

 

A health plan audit can tell you where your benefits and administration are on target and where they’re off the mark. At an average cost of less than 0.1% of most companies’ overall benefit spend – far less than the expense of high-cost claims – an audit can clarify:

Improved administrative procedures to maximize savings.


Increase quality to ensure accurate plan payments.


Recovery of overpayments from detected error patterns.


Satisfy plan fiduciary responsibilities.




90%+

Audits identify overpayments




MercerAUDIT solutions

 

How is your claims administrator performing? What areas are creating a problem, and what solutions are possible? To answer these questions, we offer a full array of health plan MercerAUDIT, including:

 

  • Medical, pharmacy, and dental claims audits using: statistical sampling, 100% claims review, targeted/focused (i.e., high cost claims)
  • Pharmacy rebate assessment focusing on manufacturer invoices and contracts, minimum guarantees, reporting, payment timing
  • Vendor and benefit implementation assessments
  • Shared savings and payment integrity program audit and fee validation
  • Appeals administration and regulatory compliance
  • Enhanced customer service evaluation



Trust Mercer for your health plan audit

 

It’s vital to identify and address vulnerabilities in your plan performance and administration. Our experts can help:


Dedicated team of specialists

 

All of our MercerAUDIT staff have over 10 years’ experience within the insurance carrier and administrator world. Performance assessment is our exclusive focus.

Depth and breadth of experience

 

We conduct more of the most-requested types of MercerAUDIT than any other firm. Our objective, unbiased review helps companies leverage their health and wellness benefits offerings and provide greater value to beneficiaries.

Proven solutions

 

With depth of experience, our team can draw insights and make recommendations that enable discussion about plan administrator performance and needed solutions. We also calculate projected savings based on immediate and future improvements to procedures and controls.

Benchmark resources

 

Mercer clients have access to an extensive audit database comparing vendor performance, established standards for measuring performance, and best practices for evaluating operations.



*Results may vary


Ready to live better, 

work brighter?

Speak with one of our consultants.

Contact us

Find out how MercerAUDIT solutions can keep your employee health and benefits program moving forward.

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