Dependent Eligibility

Dependent Eligibility Audits

The first thing to understand about dependent eligibility audits is that they are completely separate projects from claims audits. There is almost no overlap to the skills, expertise, process and even data required between the two. So why do we even address them here? Glad you asked! JGI leadership noted several years ago that we were seeing more and more RFPs that addressed both claims and dependent eligibility auditing. We looked closely at whether or not we wanted to get into the space in order to address these requests, but we ultimately came back to the position that we were better claims auditors because of the intense focus that we maintain on that service. Our solution focused on bringing best in class service from a partner firm, and we found the perfect match in MedBill Management. MBM presents several important advantages compared to its competitors, including:

  • A corporate culture that syncs with ours especially as it relates to offering flexibility in approach and pricing
  • A willingness to service the largest portion of the self-insured employer market, those companies in the 200-2,000 employee range that so many dependent eligibility audit vendors ignore
  • Exceptional return-on-investment and response rate guarantees (99%+, reduced frustration and appeals from removing dependents purely due to nonresponse)
  • Willingness to package claims audit and dependent eligibility audit services into one seamless offering to clients with a guarantee to cover the entire cost of the projects

Every health plan is paying claims for ineligible dependents. Based on our experience, 2% to 8% of dependents are ineligible for coverage for a variety of reasons which are constantly changing – marital status, financial responsibility for children, definitions and coverage rules for domestic partners, etc. JGI and MedBill Management are constantly striving to find new ways to help self-insured health plans operate more efficiently and effectively. No two dependent eligibility audits are alike, and we take the time to understand client priorities and develop a communication strategy and customized materials that fit each client’s culture. Clients find that our approach to this portion of the project is much more customized and hands-on than the industry norm, though our pricing remains competitive and our performance guarantees exceed expectations. Contracting for these combined services is seamless with integrated pricing and performance guarantees and JGI handling all project management and point-of-contact designations for client management.

Contact Us today to discuss details of your plan and how we might assist you in a dependent eligibility audit.