Explanation
The City of Columbus recently solicited responses to a formal Request for Proposal for a third party medical and dental claims audit to identify potential claims payment errors by United Health Care of Ohio (UHC) and Delta Dental respectively; recover overpayments; and ensure plans are administered in accordance with negotiated contracts. Four vendors responded to the formal RFP. Employee Benefits and Risk Management conducted an analysis of the responses, to assess their ability to perform an electronic screening and analysis, and a claims administration statistical sample field audit. A number of factors were considered including the companies' fee structure, experience in the audit industry, and reporting capabilities. The committee evaluated all candidates using the criteria set forth in Columbus City Code 329.28.
Claim Technologies Incorporated was selected to provide an audit of medical and dental claims for the period of October 1, 2012 through September 30, 2015 due to its ability to perform a comprehensive audit at the competitive audit fees. The company performed the city's audit in 2001, 2004, 2009, and 2012 and has maintained data to allow for a comparison to this year's audit. In addition, the same team will handle this process this year and Employee Benefits and Risk Management expects an expedient and thorough analysis.
This ordinance is being requested as an emergency measure to expedite the audit.
Contract compliance number is 42-1414040
FISCAL IMPACT: To enter into contract with Claim Technologies Incorporated. The maximum obligation for this contract includes an audit fee of $60,000 that includes all expenses. Payments will be made from the Employee Benefits Fund (Fund 502) in the Human Resources Department.
Title
To authorize the Human Resources Director to enter into contract with Claim Technologies Incorporated to provide the City of Columbus with an audit of UHC medical claims and Delta Dental dental claims and ...
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