Dependent Eligibility Audit Services

The vendor required to provide dependent eligibility verification audit (spouses and eligible children) enrolled in the medical, and dental plans for agency employees and retirees.
- Eliminate inappropriate spending on ineligible dependents and use the resulting information to make future financial decisions.
- After all security requirements have been satisfied, agency will provide the awarded consultant with the following:
•    A current eligibility file listing all participants who have covered dependent(s) on the included health plans. 
•    The file shall include employee and retiree name, address, phone number, health plan coverage and names of all dependents covered. 
•    Email addresses of employees may be available for the purpose of this project. 
•    Email addresses of retiree members are not available for the purpose of this project.
- Account management team
•    The awarded consultant will provide a dedicated account management team assigned to agency account to oversee and manage the dependent eligibility audit services.
- Audit process
•    A detailed plan of how the consultant will execute the proposed audit, including but not limited to contact of plan participants, document verification (clearly define acceptable documentation types for dependent verification), and timelines for data collection, analysis, draft and final reporting to agency. 
•    The vendor should communicate benchmark removal rates for an employer of the size of agency. 
•    Specify support channels (emails, newsletters) and automated reminders to improve response rates. 
•    If an employee and retiree has a question, is there a designated number for them to call the vendor. 
•    Description of any interim reporting that will be produced, and a corresponding timeline for each report
•    The consultant shall provide sample communications with their proposal. 
•    The consultant shall provide information on how they will maintain the submitted documents and how they will be secured. 
•    Elaborate on data encryption, secure portals, and access controls for document handling. 
•    Adherence and agreement to a business associate agreement will be a requirement for a successful vendor.
•    All security measures will be subject to review by internal staff of agency. 
•    The technology platform used for document submission, data management and reporting for an employer of this size. 
•    Ongoing reporting shared with agency on response rates from employees on compliance in scheduled intervals during the audit.
•    An outline of the proposed responsibilities and expectations of both agency and consultant throughout the process. 
•    Consultant staffing levels and consultant availability during the various phases of the audit.