Analysis and evaluation of claims processing for the period January 1, ...through December 31, .... administered by Blue Cross Blue Shield of Montana and Allegiance Benefit Plan Management, Inc. : final report, ...

2006·2.6 MB·English

by  Wolcott & Associates

s
368.014
L72AEC
2006
STATE OF MONTANA and
MONTANA UNIVERSITY SYSTEM
ANALYSIS AND EVALUATION OF
CLAIMS PROCESSING
FOR THE PERIOD
JANUARY 1, 2004 THROUGH DECEMBER 31, 2005
COLLECTION
STATE DOCUMENTS
jAM I 2007
MONTANA STATE UaUARY
IE15 E. 6th AVE.
-! EN/ MONTANA 5<
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Prepared Under Contract With:
MONTANA LEGISLATIVE BRANCH, AUDIT DIVISION
PO Box20170S,Helena MT59620-1^05
MontanaStaleLibrary
3 0864 1003 8893 6
LEGISLATIVE AUDIT DIVISION
Scott A. Seacat, Legislative Auditor Deputy Legislative Auditors:
Tori Hunthausen, James Gillett
ChiefDeputy Legislative Auditor Jim Pellegrini
November 2006
The Legislative Audit Committee
ofthe Montana State Legislature:
Enclosed is the report on the audit ofthe medical and pharmacy claims forthe employee benefits plans at
the State ofMontana and the Montana University System forthe two years ended December 31, 2005.
The audit was conducted by Wolcott & Associates undera contract between the firm and ouroffice. The
comments and recommendations contained in this report represent the views ofthe firm and not
necessarily the Legislative Auditor.
The agencies' written responses to the report recommendations are included in the back ofthe audit
report.
ectfully submi
Scott A. Seacat
Legislative Auditor
06C-07
Room 160 StateCapitol Building PO Box 201705 Helena, MT 59620-1705
Phone[phone] • FAX [phone] E-Mail [email protected]

Digitized by the Internet Archive
in 2011 with funding from
Montana State Library
http://www.archive.org/details/analysisevaluati2006wolc
STATE OF MONTANA and
MONTANA UNIVERSITY SYSTEM
ANALYSIS AND EVALUATION OF
CLAIMS PROCESSING
FOR THE PERIOD
JANUARY 1, 2004 THROUGH DECEMBER 31, 2005
ADMINISTERED BY
BLUE CROSS BLUE SHIELD OF MONTANA and
ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC.
FINAL REPORT
DECEMBER, 2006
PRESENTED BY
WOLCOTT & ASSOCIATES, INC.
12120 STATE LINE ROAD, SUITE 297
LEAWOOD, KANSAS 66209

111
STATE OF MONTANA AND MONTANA UNIVERSITY SYSTEM
HEALTH CARE PLAN AUDIT
OF BLUE CROSS BLUE SHIELD OF MONTANA AND
ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC.
JANUARY 1, 2004 - DECEMBER31, 2005
TABLE OF CONTENTS
SECTION PAGE
INTRODUCTION
I- 1-1
U - STATISTICAL CLAIM AUDIT RESULTS - STATE & MUS n-i
ELIGIBILITY m-i
III -
IV - BCBSMT & ALLEGIANCE REIMBURSEMENT IV-
V - CLAIM PAYMENT TURNAROUND TIME v-i
VI - COST CONTAINMENT VI-
VII - LOGIC AND OTHER TEST RESULTS VII-
OTHER REVIEW AREAS vm-i
VIII -
IX - PRIOR AUDIT RECOMMENDATIONS LX-l
EXHIBITS
DESCRIPTION OF ERRORS STATE & MUS (BCBSMT) EXHIBIT A
-
DESCRIPTION OF ERRORS MUS (ALLEGIANCE) EXHIBIT B
-
RESULTS OF SYSTEM TESTS EXHIBIT C
BLUE CROSS BLUE SHIELD OF MONTANA RESPONSE - Traditional EXHIBIT D
ALLEGIANCE BENEFIT PLAN MANAGEMENT, INC. RESPONSE - Trad. EXHIBIT E*
Allegiance chose not to provide a response to the report