Health Plan - TPA Audit - References?

[Guest Kelli Kennedy]

I am looking for someone to audit our TPA for a self-funded health plan. We average about $35 million in claims paid each year. Our management does not want to use our normal auditors for business reasons. Does anyone has a references that have performed this type & size of audit for your company before? Thanks!

[Guest BENEFISH]

We have used BMI Audit Services and have found their work to be superior. They are true objective claims auditors and fees are not based on amount of recoveries. True professionals and effective. Our plan is about $31,000,000. I know they have done audits for much larger plans as well. Contact them through their website www.bmiaudit.com

[Guest EMK]

Try Tom Farley at 212-309-3711. He is with Towers Perrin.

[JWK]

I can't suggest an auditor, but in deciding who to engage, you should have a clear idea of what you want the audit to accomplish and what you will do if the audit uncovers claims-paying errors. I have seen plan sponsors spend well into five figures for audits without knowing what to do with the results. What does the agreement with the TPA say about remedies for claims errors? Do you have to prove "gross negligence" as a condition to any contractual remedy? I encourage you to look into these issues before you start paying an auditor.

[Guest marvin]

WE have used BMI audit serveces to review our plan claim peformance with very good results. They made some strong recommendations to plan changes and policy changes at the adm that was mutually beneficial. I have their corp number at 219.234.9511.

[Guest Jack Hill]

I suggest you contact Kathy DelFavero, President of HBCI. Kathy is one of the best TPA claims auditors in the country. She did a lot of work for me when I ran a national reinsurance company. Since that time, I have used Kathy for operational reviews on HMOs, TPAs, and insurance companies. You can reach Kathy at 630-406-1959. Her e-mail is HBCI@aol.com.

Good Luck