Eligibility Quality Controls:
How did we get here?
Health plan enrollment has lacked any meaningful Internal Controls for decades. For instance, enrollment forms have not changed much since the 70s. Moving enrollment to the Web simply compounds the problem. This outdated process was designed to facilitate gaining coverage through an employee signature, but paper and web forms fails to verify the eligibility of dependents.
The fact is that most providers don’t have the infrastructure, systems, or incentives to ensure quality control.
In order to have effective controls you need:
- A comprehensive evidence based verification process; and
- A Gate Keeper solution that takes ongoing events such as hires, fires, promotions, weddings, divorces, COBRA, etc. into account and manages eligible dependents.
Do you have effective quality controls for your health plan(s) dependent eligibility?
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●Lowering Healthcare Costs
● Eligibility Case Study
● What Can Go Wrong?
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