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AGENDA ITEM REVIEW FORM |
3.A.
Employee Benefit Trust Board Meeting
- Meeting Date:
- 09/14/2022
- Department Head:
- Adela Cortez
- Submitted By:
- Maria Barajas Gutierrez, Human Resources Coordinator, Human Resources Department
ITEM:
Discussion and possible action on any and all matters regarding the review and approval of SIARMED audit proposal from Wolcott & Associates, Inc. (Susan Posada, Broker and Consultant)
SUMMARY:
The City of San Luis sponsors self-insured health care plans (for medical and dental). 90 Degree Benefits provides the claim payment service for these plans and utilizes the Siarmed network. These services include repricing of the network, claim payment, printing of participant ID cards and the maintenance of enrollment and eligibility records. The City of San Luis considers a regular audit of its claims to be prudent. Audit will be performed by selecting a sample of 250 processed claims. Each claim will be manually recalculated to verify that proper payment has been made based on the plans provisions. This process will include verification of allowable charges and services against the plan's provisions, verification of deductible and coinsurance satisfaction based on a review of the payment history for the patient, and verification of benefit coordination based on Coordination of Benefits data provided by employees. Benefits Consultant will be providing a report on SIARMED audit findings to the Trust.
RECOMMENDATION / SUGGESTED MOTION:
I MOVE TO APPROVE WOLCOTT & ASSOCIATES' FIFTEEN THOUSAND DOLLAR ($15,000.00 ) PROPOSAL TO AUDIT SIARMED CLAIMS.
Fiscal Impact
Fiscal Impact:
Total cost for audit, including out-of-pocket expenses, will be $15,000 for a stratified sample size of 250 medical/dental claims.