Dependent / Eligibility Audits & Enrollment Management

A very powerful cost containment management tool today is effective eligibility administration. Precise eligibility controls are essential for the sound performance of your health plan. ACCURATE ensures that a client’s eligibility records are updated timely and accurately, to protect against fraud and other ineligible expenses.

Information necessary for proper administration is tracked through the eligibility system which is fully integrated with claim adjudication programs and fully historical. This means that claims are adjudicated in accordance with the specific plan, network and eligibility in effect at the time the service was obtained.

Dependent verification and full dependent audit services are available under which ACCURATE enrollment and eligibility analysts can review actual documentation of eligibility such as marriage licenses, birth certificates, divorce decrees, school accreditations, etc.

ACCURATE also provides the tools to adjust eligibility status at the precise moment an eligibility event occurs, by offering enrollment maintenance with daily updates that allow clients to manage eligibility information for their members in real time. Eligibility record changes become effective in real time after they are entered in the system.

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