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Benefit and Care Plan Audits

Dependent Eligibility, Claims and Care Management Audits

When you need to ensure health plan compliance and control overall benefit costs without actually reducing the benefits that are offered, a benefit plan audit can determine if claims are being administered accurately and eligible dependents are correctly covered according to the guidelines of your plan.

Our benefit plan audits include:


Dependent Eligibility Verification: Through a series of communications and required action items that guide employees through the dependent verification process, we can help your organization identify ineligible dependents and remove them from your benefit plans.


  • Medical
    • Our traditional Stratified audit methodology provides statistically valid results, inferring administrator financial and procedural performance accuracy.
    • Our Interactive Qualification (iQ) audit methodology, delivered through our proprietary software, evaluates 100% of claim data and identifies the areas of greatest potential financial risk.
  • Rx: Using our iQ audit methodology, we analyze 100% of claim data for administrative, regulatory, plan guidelines, and contractual parameters, such as discount guarantees.

Care Management

Clinical Care Management and Operations Audit: Utilization and case management programs are designed to ensure that the medical services meet accepted clinical criteria for coverage under the plan. The audit includes a review of processes designed to assess not only the program structure, but also program execution and the clinic’s subsequent impact on health and financial outcomes.

Featured Content


Audit and Reporting Services Overview (PDF, 314 KB)

Dependent Eligibility Verifications (PDF, 305 KB)

Medical Claim Audit Services (PDF, 366 KB)

Rx Claim Audit Services (PDF, 237 KB)

Clinical Care Management and Operations Audit (PDF, 180 KB)

Case Studies

Dependent Eligibility Verification

Dependent Eligibility Verifications – Energy (PDF, 362 KB)

Dependent Eligibility Verifications – Health Care (PDF, 222 KB)

Dependent Eligibility Verifications – Municipality (PDF, 247 KB)

Claims Audits

Medical Management Audits | United Health Services (PDF, 166 KB)

Pharmacy Claim Audit – Manufacturing (PDF, 174 KB)

Pharmacy Claim Audit – Municipality (PDF, 204 KB)

Care Management Audits

Onsite Clinic Strategic Planning (PDF, 267 KB)

Onsite Clinic Evaluation | Glatfelter (PDF, 372 KB)

Clinical Audits – Employer (PDF, 183 KB)

Clinical Audits – Health Plan (PDF, 237 KB)

Health and Productivity Services

  • Absence Management Services
  • Benefit and Care Plan Audits
  • Engagement and Portal Strategies
  • Exchange Strategies and Solutions
  • Federal and State Regulatory Compliance
  • H&W Brokerage Services
  • Health Analytics
  • Health Care Supply Chain Management
  • Health Strategy and Financial Management
  • Pharmacy Plan Consulting
  • Post-Retirement Medical Valuations
  • Voluntary Benefits

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We provide consulting services. We do not provide legal services, tax services nor otherwise engage in the practice of law.