Audit controls - reduce abuse

Active Health Audit Strategies

Claim Payments

Review a detailed claims listing to ensure that claims are paid according to the schedule of benefits.

Tax Payments

Review the invoices to make sure that the provincial sales tax was remitted correctly and applied properly to adjustments.

Review the annual financial statement to ensure it uses an appropriate treatment of taxes for refunds or deficit recovery.

Reconcile Financial Statement

Compare the detailed claims listing and monthly invoice to the totals in the renewal report and financial statement.

Eligibility

Review a list of participating members to ensure that everyone that should be included is and only those eligible are participating.

Claim Adjudication

Scrutinize the documentation for a sample of the various claims to ensure adequate evidence is obtained before claims are paid.

Risk Management

Review the documentation concerning reported and potential:

• death claims
• disability claims
• waiver of life premiums
• extension of benefits

PrivacyDisclaimerCopyright ©Benefits Interface, Inc.