2005-035 Health Insurance Claims Audit - Siver Insurance Consultants
RESOLUTION 35-2005
A RESOLUTION OF THE VILLAGE COUNCIL OF THE VILLAGE OF NORTH PALM
BEACH, FLORIDA, ACCEPTING THE PROPOSAL OF SIVER INSURANCE
CONSULTANTS, ATTACHED AS EXHIBIT "A", TO AUDIT VILLAGE MEDICAL CLAIM
PAYMENTS FOR A TWELVE-MONTH PERIOD ENDING JANUARY 31, 2005;
AUTHORIZING AND DIRECTING THE VILLAGE MANAGER TO NEGOTIATE A
CLAIMS AUDIT AGREEMENT WITH SIVER INSURANCE CONSULTANTS FOR
PRESENTATION TO AND APPROVAL BY THE VILLAGE COUNCIL; AND,
PROVIDING FOR AN EFFECTIVE DATE.
BE IT RESOLVED BY THE VILLAGE COUNCIL OF NORTH PALM BEACH, FLORIDA:
Section 1. The Village Council of the Village of North Palm Beach, Florida, does hereby
accept the proposal of Siver Insurance Consultants attached as Exhibit "A" to audit Village
medical claim payments for atwelve-month period ending January 31, 2005; authorizing and
directing the Village Manager to negotiate a claims audit agreement with Siver Insurance
Consultants for presentation to and approval by the Village Council.
Section 2. This resolution shall take effect immediately upon its adoption.
PASSED AND ADOPTED THIS 14th DAY OF APRIL, 2005.
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VILLAGE CLERK
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Inrurm~ce
Consultants
IVER
9400 Fourth Street North, Suite 119
St. Petersburg, Florida 33702-2525
Post Office Boz 21343
St. Petersburg, Florida 33742-1343
Telephone: (727) 577-2780
Fax: (727)579-8692
E-mail: river@siver.com
Website: httpJ/www,siver.com
March 09, 2005
Mr. Mark Bates
Village Manager
sol v.s. Highway #1
North Palm Beach, FL 33408
Re: Request for Proposal: Health Claims Audit of Third Party Plan Administrator
Dear Mr. Bates:
We are in receipt of the Email notice issued on March 8, 2005, indicating a revised bid
opening date of March 29, 2005, for proposals to conduct an audit of the claims
administration services provided by Employers Mutual, Inc.
Siver previously issued a proposal in response to the earlier Request for Proposals
(original stated bid opening date of February 22, 2005). It is our understanding that the
original proposals have not been reviewed, and in fact are still sealed. Please accept
this letter as confirmation that Siver's original proposal response, including pricing,
remains valid for the new bid opening, scheduled for March 29, 2005.
For your convenience and to insure our place in the March 29, 2005 bid opening
process, we have enclosed one additional copy of our original proposal.
Thank you for the opportunity to participate in this proposal process.
Sincexely,
SIVER INSURANCE CONSULTANTS
~'L° _~.
Brenda M. Sadler
Vice President
EIlC10SlU'e J:1EWB120051Client l)evelopmentlVNPB new RFP date.doc
VILLAGE OF NORTH
PALM BEACH
PROPOSAL:
CLAIIYIS AUDIT' OF
THIRD PARTY ADMINISTRATOR
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Provided by:
Siver Insurance Consultants
9400 Fourth Street North, Suite l ~9
St. Petersburg, FL 33702
Toll Free (866) 967-4837
Contact: Brenda Sadler, Vice President
• February 22, 2005
B: TABLE OF CONTENTS
TAB
Title Page .......................................................... ..........................................A
Table of Contents .......................................................................................... B
Letter of Transmittal .................................. ................................... C
ProfJe of the Proposer ....................... ._. D
........................................................
Summary of the Proposer's Qualifications ................................................ E
References ........................................................................................ ......... F
Fee 5chedule ..................................................................................................G
C': LETTER OF TRANSMITTAL
The following characterizes our understanding of the scope of services to be performed and
outlines our typical audit process.
Proposed Services
Siver proposes to conduct a Claim Audit for the Village of North Palm Beach to include the items
reflected in Section III (Scope of Services) of the Request for Proposal (RFP}issued on January 28,
2005. Upon completion of our review, a detailed written report will be provided, outlining the audit
findings, including Siver's recommendations to cure any discrepancies indicated during the course of
the audit and our assessment of any financial penalties applicable, consistent v~~ith any contracts or
agreements in place during the stipulated audit period.
DJhile the RFP indicates a 100% review of all claims processed for medical, dental, hospitalization,
and prescription drugs, it is recommended that an initial audit of approximately 400 claims (for the
audit period of July 1, 2003, through June 20, 2004) be conducted, with the Village ofNorth Palm
Beach having the option to increase the size of the audit sample, should the initial audit reveal
significant discrepancies. The suggested audit sample of 400 claims represents approximately 5% of
the medical, dental and prescription claims processed during the audit period, based on figures
obtained from the Third Party Administrator. A 5% audit is consistent with industry standards.
The on site audit schedule will be determined by mutual agreement with the Village of North Palm
Beach, Siver, and Employers Mutual, Inc. It is anticipated that four to fve days will be required to
perform the on site portion of the audit process.
Explanation of Typical Audit Parameters
1. Overall Accuracy -The percentage of claims processed correctly in every aspect, including;
coding, procedures, financial accuracy, eligibility, and turnaround tune. If a claim payment
has any error on it, financial, procedural, or otherwise, it is counted as one inaccurate claim.
Multiple errors on the same claim will count as one inaccurate claim.
2. financial Accurate -The total sum of absolute dollars of al! underpayments and all
overpayments divided by the total dollars of claims paid.
3. Turnaround Time - Number of working days elapsed between the date the claim is received
by the claims paying vendor and the date the claim is either processed for payment, processed
for denial, or pended for further information/documentation.
O tional Audit Services (not included in basic quote)
1. Eligibility Updates- Number of working days elapsed between the date the record is received
b;~ the claims paying vendor and the date the eligibility is updated.
2. S~~stem_ Change Requests- Number of working days elapsed between the date the client
• requests an update (i.e., fee schedule revision) and the date the revision is updated in the
claims system.
Siver's Typical Audit Process
Phase 1
The audit will be conducted primarily at the TPA office, on a date to be determined. A letter
authorizing Siver to obtain data on behalf of the client should be issued as soon as possible.
Prior to the dates of the on site audit, Siver will confirm the audit schedule and request the
required materials from the TPA. A detailed paid claim report for the period to be audited is
required, along with copies of any system codes and copies of plan documents.
From the detailed claim report, we randomly select the claims to be audited and request the TPA
have those claims and all related documentation available for review at the time of ow on site
visit. In this case, random claim selections will be made from the medical, dental, and
prescription plans. We recommend an initial audit of 400 claims, with the client having the
ability to expand the audit, should significant discrepancies be found in the initial review.
Phase 2
This phase includes the examination and recalculation of the claims that were selected for audit.
As each claim is audited, results are recorded. Spreadsheets, showing data collected for each
claim, will be included as a portion of the final audit report, with identifying data redacted in
compliance with HIPAA privacy guidelines.
Phase 3
This phase includes a brief exit interview with Siver and the TPA to share preliminary audit
findings and discuss the procedure Siver wiU foIlow in communicating audit results to the Client.
The TPA will be provided a preliminary draft spreadsheet of ow findings, prior to submission of
the final report to the Client. The TPA is typically given up to two (2) weeks to challenge any of
the initial audit findings. A written response is required from the TPA if there aze any challenges
to our report. Siver will review any challenges and make report revisions, if appropriate.
Phase 4
A report will be provided to the Client to include any suggested penalties or monies due as a
result of our audit findings, in accordance with any existing performance standazds. In the
absence of a performance agreement, recommendations for improving services (if indicated) will
be presented. These recommendations would include a suggested date far completion of any
necessary training, system changes, etc. It would be our hope that the TPA would sign an
agreement to complete required enhancements within 34 days or less of the final report.
Firm/Staff Details
Brenda Sadler, the assigned auditor, has more than 20 years of auditing experience. Ms. Sadler has
conducted audits of numerous third parry administrators and insurance cazriers. A listing of those
firms and a copy of her curriculum vitae is provided under Tab E. Brenda Sadler, Vice President,
and George Erickson, Executive Vice President, are authorized to make representations for Siver and
• may be reached, toll free, at (866) 467-483 7. Ow office is located at 9400 Fourth Street North, Suite
119, SL Petersburg, Florida, 3?702. Additional details pertaining to Siver are located in Tab D.
D: PROFILE OF THE PROPOSER
Siver Insurance Consultants (Siver) is an independent employee benefits, risk management, and
insurance consulting firm located in St. Petersburg, Florida, in business since 1970. Siver is entirely
owned by its officers and employees. We are independently owned and not related to, or affiliated
with any other organization.
We do not sell insurance. We do not receive, directly or indirectly, any commissions, contingent
commissions, or overrides. All of our income is directly derived from the fees we charge our clients.
All income we receive as the result of, or in connection with, our services to a client will appear on
our invoice to that client. We adhere to a strict code of ethics. We do not accept gifrs, trips, prizes,
or anything else of any value from vendors. ]n short, we serve only our clients.
Siver's staff is highly qualified, including individuals with advanced degrees (including law and
insurance), and has the skills and knowledge necessary to provide the services requested. Siver staff
members have had substantial firsthand experience in providing a broad range of consulting services
to numerous, and widely divergent clients.
Following is an organizational chart reflecting our permanent staff. Siver also engages the
specialized services of a number of adjunct consultants who work with us on an as needed basis.
Those individuals are not reflected in this exhibit.
We offer ezpertise in the following areas:
Litigation Support/Expert Witness
Employee Benefits
Risk Management.
Auditing Services
Life, Health, & Disability Insurance
Property & Casualty Insurance
Managed Care
Title Insurance
•
SIVER GOVERN'.-ZENTAL CLIENTS {Current and Previously Served):
CITIES
Altamonte Springs, FL
Apopka, FL
$artow,FL
Charlotte, NC
Clearu-ater, FL
Coconut Creek, FL
Coral Gables, FL
Dania Beach, FL
Da}KOna Beach, FL
Deerfield Beach, FL
Delray Beach, FL
Fort Myers, FL
Fort Pierce, FL
Gainesville, FL
Gulfport, FL
Holly Hill, Fl:,
Hollywood, FL
Homestead, FL
Jacksonville, FL
Key West, FL
Lakeland, FL
Largo, Fi.
Maitland, FL
Melbourne, FL
Miami Beach, FL
New Smyrna Beach, FL
Orlando, FL
Palm Bay, FL
Palmetto, FL
Pensacola, FL
Pinellas Park, FL
Richmond, VA
Rockledge, FL
Safety I•larbor, FL
St. Augustine, FL
St. Petersburg, FL
St. Pete Beach, FL
Sanford, FL
Sanibel, FL
Sarasota, FL
Sebastian, FL
Tarpon Springs, FL
West Palm Beach, FL
Winter Haven, FL
COtiNTIE5 & STATES
Alachua County, FL
Brevard County, FL
8roward County, FL
Charlotte County, FL
Collier County, FL
Desoto County, FL
Henrico County, VA
Hernando County, FL
Highlands County, FL
Hillsborough County, FL
Imperial Polls County, FL
Indian River County, FL
Lake Gounty, FL
Lake County, Clerk of the
Circuit Court
Lee County, FL
Manatee County, FL
Martin County, FL
Mecklenburg County, NC
Orange County, FL
Putnam County, FL
St. Johns County, FL
St. Lucie County, FL
Sarasota County, FL
Seminole County, FL
State of Florida
pISTRICTS & AUTHORITIES
Alachua County Library District
Housing Authority of Avon Park
Broward County Airport Authority
Broward County Sheriffs Office
Clearwater Housing Authority
Council of Governments
Florida Department of Labor and
Employment Security
Florida Department of
Transportation
Fort Pierce Utilities Authority
Gainesville Housing Authority
Hillsborough County Aviation
Authority
Jacksonville Electric Authority
Jacksonville Port Authority
Jacksonville Transportation
Authority
City of Key West Utility Board
Manatee County Housing
Authority
Naples Airport Authority
New Smyrna Beach Utilities
Commission
North Naples Fire Control and
Rescue District
Orlando Utilities Commission
Greater Orlando Aviation
Authority
Palm Beach County Sheriffs
Office
Palm Hazbor Special Fire Control
District
St. John's River Power Park
Project
Sarasota-Manatee Airport
Authority
South Florida Conservancy
District
South Flotilla Water Management
District
South Trail Fire Protection and
Rescue Service District
Space Coast Labor Management
Health Coalition
Sumter County Sheriff's Office
Tampa Housing Authority
Tampa Port Authority
EDUCATION
Broward County School
Board
Charlotte County School
Board, FL
Charlotte County Board of
Public Education, NC
Duval Couaty School Board
Eckerd College
Florida Community College
Florida Community College
of Jacksonville
Hetuico County School
Boazd, VA
Hillsborough County School
Board
Lake County School Board
Manatee Couary School
Board
Mecklenburg County School
Board, NC
Miami-Dade Community
College
Miami-Dade County Public
Schools
Scbool Board of Palm Beach
County
Pinellas County School Board
Polk County School Board
Putnam County School Board
School Board of Sarasota
County
School Board of Seminole
County
Shorecrest Preparatory School
St. John's Junior College
St. Petersburg Junior College
The Vanguard School
SIVER NON-GOVERNMENTAL CLIENT'S (Current and Previously Served):
AGRICULTI.'RE
4merican Agronomics
corporation
Golden Gem Growers.
tnc.
3rassland Development
:,orporation
Hollins Corporation
.CN of Delaware, Inc.
Che Powell Group
Purley, Inc.
~ua[iry Grassing &
>ervices, Inc.
COMMUNITY
1SSOCIATIONS
.000 Island Blvd.
Condominium Assoc.
':600 Island Blvd.
condominium Assoc.
1800 Island Blvd.
Condominium Assoc.
000 Island Blvd.
condominium Assoc.
4000 Island Blvd.
condominium Assoc.
'000Island Blvd.
Condominium Assoc.
Roca Graade Club
'he Charter Club
.;lub Longboaz Beach &
Mediterranean Village
Master .4ssociation
ocean Reef Club
Pirates Cove
^ondomiaium Assoc.
ort Royal Club
un Top of The World
Owners Property
danagemcnt
.eef Resort
;,ondominium
association
owers of Quayside No.
2 Condominium Assoc.
Williams Island Property
?wners Association, Inc.
,~~ispering Waters
Condominium Assoc,
is
elican Cove
CONTRACTOR/DEVELOPER
All State Homes
Lee Arnold & Associates, Inc.
Barron Collier Corporation
Bay Plaza Cos.
Baymont Engineering Company
Burnup & Sims, Inc.
Coastal Steel Construction Co.
DDI, Inc.
Eastern Environmental Services, Inc.
F & S Frame & Trim, Inc.
Florida Progress Corporation
Hallmark Development Corp.
Krauss Company
North Florida Concrete
Paragon Group, Inc.
Parsons Brinckerhoff Construction
Services, Inc.
Arthur Rutenburg Homes
Shimberg Enterprises,lnc.
Southeast Capital Corporation
Wadsworth Development Company
P. Wallenberg Development Co., Inc.
Wellington Real Estate
J. H. Williams Oil Company
FL'VAtiCIAL
1TiSTi(TUTIONS
Bay Financial Savings Bank
Centerbanc Savings
Chrysler Capital Corporation
Community Bank
First National Bank of
Okaloosa
FMI Financial Corporation
Hendry County Baalc
Heritage Federal Savings &
Loan Association
Home Builders Insurance
Services, Inc.
Landmark Union Trust Bank
of St. Petersburg
McNulty Banking Company
Mutual Fire Policyholders
Committee
National Bank of Lee County
New Hampshire Insurance
Group {AlNetwork)
Park Banks of Florida, Inc.
Pioneer Savings Bank
RJ. Financial Corporation
Rockwood Programs, Inc.
Southeast Capital Consulting
SouthTrust Bank
Suncoast Schools Federal
Credit Union
T.R Jones & Company
HEALTH CARE
All Children's Health System
Allegany Health Systems
AMI/F'lorida Region
Anesthesia Professional
Association
Bay Area Renal Stone Center
Bay Medical Clinic, Inc.
Bayfront Medical Center
Cedars Medics] Center
Dun & Bradstreet Play
Services, Inc.
Duval County Beaches Public
Hospital Board
FirstHealth of the Carolinas
Heritage Hospital (formerly
Centro Asturiano Hospital}
Highlands County Hospital
District
HEALTH CARE (Cont'd)
Indian River County Hospital
Authority
Indian River Memorial
Hospital
Manatee Memorial Hospital
Measc Health Care
Mcase Hospital
Mease Manor, Inc.
Memorial Regions!
Rehabilitation Center
Memorial Medical Center of
Jacksonville
Memorial Hospital of
Jacksonville
Metropolitan Genera] Hospital
H. Lee Moffitt Cancer Center
& Research Institute
Morton F. Plant Hospital
Mount Sinai Medical Center
Pathology Associates
S.A. Insurance, Ltd
St. Anthony's Health Care
Center, Inc.
St. Anthony's Hospita!
St. Francis Hospital
St. Joseph's Hospital
St. Luke's Hospital
Association
St. Mary's Hospital
Shaads Teaching Hospital &
Clinic
South Broward Hospital
District
South Florida Baptist Hospital
STRAIGHT, Inc.
Suncoast Hospital
Suncoast Osteopathic Hospital
SunHealth Care Plans -Gulf
Coast, Inc.
Tallahassee Memorial
Regional Medical Center
Unipsych
University Community Hospital,
Inc.
University Medical Center
Venice Hospital
Vision Care Network
Winchester Gardcas
Winter Haven Hospital
SIVER'~ON-GOVERN".VIENTAI. CLIE~iTS (Carrent and Previously Served, Continued):
MANUFACTURING
4dvance Plasma
iystems, Inc.
American District
Telegraph Company
diamond Products
company
Hughes Manufacturing,
nc.
'recisionatre, Inc.
Saddle Creek
corporation
3tant Corporation
~'hompson & Co., Inc.
Tiffany Furniture
ndustries, Inc.
"ri-Chem, Inc.
Tropical Garment
QOT-FOR-PROFIT
Clearwater PACT', Inc.
Florida United Methodist
:hildren's Nome
Joodw~ill Industries
Suncaast, Inc.
'ohn Knox Village
OTHER ENTERPRISES
Alf Eiated of Florida, Inc.
Allied International Holdings
American Rental DeaEers Insurance
The Beacon Group, LLC
Sam P. Broady, Inc. Communications
Chtuc6 & Tower, Inc.
Russ Cline & Associates
Equity Associates
FCA Fruit & Vegetable (FFVA)
Insurance
Florida First Service Insurance
FFVA Mutual Insurance
Florida Lawyers Legal Insurance Corp.
Florida Power & Light
J.D. Gamer & Associates, Inc.
Jim Garrison, Inc.
Hardrives Company
Hollins Corporation
Insurance Catastrophe Consultants, Inc.
Laney & Duke Warehouse Company
Lucas Ford Associates, inc.
Morefar Marketing, Inc.
Michael Mullery, M.D.
PDG Environmental
Performance Feeders, Inc.
The Pierre Association, Inc,
Pce & Associates, Inc.
Universal Studios of Florida
Valjean Corporation
RECREATIONISPORTS
Biscayne Kennel Club
Boca Grande Club
Carlouel Yacht Club, Inc.
The Center Foundation, Inc.
Feather Sound Country Club
The Florida Aquarium
Florida Suncoast Dome
International Speedway Corp.
Major Bowl Association
NASCAR, Daytona Beach
Orange $ow1 Committu
Pon Royal Club
St. Petersburg Grand Prix
St. Petersburg Yacht Club
Tampa Yacht & Country Club
Venice Yacht Club
RETAIL/WHOLESALE
B & R Foods Holding, Inc.
Badcock Economy Furniture
Stores, Inc.
W. S. Badcock Corporation
Baymont Technologies, Inc
Beico Electric, Inc.
Bishop's Welding Supply
BuyingBrain
Coral Cadillac
Cox Lumber Company
Davgar Restaurants, Inc.
Dew Cadillac, Inc.
Diamond Motor Sports
Dick DeVoc Buick-Cadillac,
Inc.
Dimmitt Cadillac, Inc.
Gate Petroleum
Gerhardt's, Inc.
Great Bay Distributors, Inc.
Grevgold Enterprises
Hav-a-Tampa Corporation
Hospitality Resources, Inc.
Kane Furniture Company
Leroer Corporation
Logan Lumber Company
Jim Lynch Enterprises, Inc.
Manufactured Housing
Products
Marlow-Weroer Pontaac-
Buick-GMC
McNichols Co.
Mid-America Industries, Inc.
National Merchandise Co., Inc.
Oyster Bar of Clearwater
Parkway Food Service, Inc.
Pic'N Save Drug Co., Inc.
Sacino & Sons,Inc.
Save On Seafood Company
Scotry's, Inc.
Thomas Restaurant
Management
United Auto Parts
United Seafood Imports, inc.
Wal-Mart Stores, Inc.
Witte-Dixie Stores, Inc.
Yesterday's Restaurant
7_ier, Inc. dba Discount
tlniform
TRANSPORTATION
Emery Air Freight Corporation
Joule Yacht Transport, Inc.
People Express Airline, Inc.
Purolator Courier Corporation
Shaw Trucking Company
Sun State Marine, Inc.
TRUSTS & ASSOCIATIONS
American Association of Airpor
Executives
American Dental Association
Automotive Warehouse
Distributors
Broward County Consolidated
Consortium
Federal Realty Investment Trust
Florida Associated General
Contractors Benefit Trost
Florida Association of Counties
Florida Association of Insurance
Agents
Florida Bar Association
Florida Comprehensive Health
Association
Florida Health Caze Association3
Florida Peroleuun Marketers
Health
Florida Pest Control Association
Greater Tampa Association of
Realtor
Group Health Benefits
Purchasing Consortiwn
Hillsborough County Purchasing
Department
Idaho Cattleman's Association
National Association of
Building Service Contractors
Pinellas Classroom Teachers
Association
Prestressed Concrete institute
E~ SU:VIMARY OF THE PROPOSER'S QUALIFICATION,
Brenda Sadler, Vice President and Siver's practice leader for the Employee Benefits Diva
primary individual assigned to this audit project. Ms. Sadler has over 20 year of auditing expe,
having audited multiple carriers and third party administrators. Ms. Sadler's background incIu~
several years experience in claims adjudication and claims auditing and also served as the manager
of a third party administrator in Atlanta, Georgia. Her knowledge of various claims adjudication
systems as well as her experience with both self-funded and fully insured programs provides Ms.
Sadler with the expertise to perform the requested services. Additionally, Ms. Sadler is frequently
called upon to interpret policy language as well as normal :idustry protocol. She personally
conducted each of the audits listed in our proposal response to the request for references, located
under Tab F. Ms. Sadler's curriculum vita is attached for your review, following this page.
Insurers and Third Party Administrators Audited bV Ms. Sadler
Insurers Third Pa Administrators
Aetna Administrative Services, Inc.
Blue Cross Blue Shield Anchoz
CIGNA Anthem
Confederation Life Benefit Services, Inc.
Florida Healthcare Coo erative Florida First
Prudential Hunt
Trustmark Jenkins & Associaxes
Em io ers Mutual, Inc. Robe Barber
Talma e
BRENDA M.SADLER
Vice President & Senior Consultant
EDUCATION
State of Florida Life Health and Variable Annuity License -Certified Employee Benefits Specialist
(CEBS) Recognition of Academic Achievement in Group Benefits through the University of
Pennsylvania -Completed full course of study through Health Insurance Association of America
(HL4A}
BUSINESS EXPERIENCE
Over 32 years' experience in the Health and Welfare Industry with a focus on managed care, client
development, underwriting, product analysis and rate negotiation -Heavy claims background,
including management ofa Third Party Administrator (TPA) organization and over 20 years' claims
auditing experience
AREAS OF EXPERTISE
Underwriting skills and renewal evaluations -Plan design -Enrollment material development -
Policy & Procedure development -Claims audits -Network negotiations -Contract negotiations -
SPD design -Product analysis -COBRA & HIPAA Compliance-RFP Development- Proposal
Analysis
Prior Senior Management position with a major group insurance company -Committee member for
Member Education, Quality Improvement, NCQA, Risk Management, and Disease Management
Programs
PROFESSIONAL ACTIVITIES
Florida West Coast Employee Benefits Council (1996 & 1997} - 1997 FAHMO Event Conunittee -
Inroads Mentor (1996 & 1997) -National Association for Female Executives (NAPE) (1999-2001)
Current member of Leadership Tampa Alumni (Class of `97), - Intemataonal Foundation of
Employee Benefit Plans {IFEBP) -Member, Society of Risk Management Consultants, -Business
Member of FERMA
Brenda ht. Sadler - (Continued)
PARTIAL LIST OF CLIENTS PREVIOUSLY SERVED
• Charlotte Mecklenburg School System
• City of Dania Beach
• City of Fort Pierce
• City of Charlotte {NC)
• City of Holly~vvood
• City of Miami Beach
• City of St. Petersburg
City of Tampa
• City of Winter Haven
• Coca Cola Corporation
• DANKA
• Fiserv
• Flagler (The Breaker's)
• Florida Power Corporation & Florida Power & Light
• Fort Pierce titilities Authority
• Fort Worth School District
• Hillsborough County Goven~unent
• Hillsborough County Indigent Health Care Plan
• Hillsborough County School District
• Lee County Sheriff's Office
• Logan Lumber Company
• Martin County School Board
• McNichols Company
• North Naples File Control & Rescue Unit
• Northern Telecom {Nortel)
• Palm Harbor Special Fire District
• Perkins Restaurants
• Pic `N Pay Shoes
• Pinellas County School Board
• Polk County Schools
• Raymond James Financial
• Shriner's Hospital
• Staffing Concepts
• Tampa General Hospital
• Tech Data
• TECO
• Thompson & Company
• Times Publishing
• Tucson Electric Power
• University of Arkansas
F: REFERENCES !client audits conducted ~~ithin the last three nears)
FORT PIERCE UTILITIES AUTHORITY
206 South Sixth Street
Fort Pierce, FL 34950
Mr. Doug Giel
Director of Human Resources
Tel.: (772) 466-1600 ext. 3265
Fax.: (772) 429-2035
Email: d iel(a~fyua.com
S fiver has conducted numerous audits for this client. Our most recent audit was performed the week
of February 7, 2005. This audit included review of medical, dental, and prescription drug claims for
the plan yeas 2004. The final results of this review of services provided by the Third Parry
Administrator, Employers Mutual, Inc. are pending client review.
HILLSBOROUGH COUNTY GOVERNMENT
601 E. Kennedy Blvd.
Tampa, FL 33602
Mr. Jack Kroil Ms. Lillie H. Joe
Finance Services Manager Contracts Manager
Tel.: {813) 272-5040 Tel: {813) 301-7341
Fax: (813) 276-2865 Fax: (813) 276-2865
Email: krollj(a~hillsborou hg_countv.org Email: ioelnu,hillsboroughcounty.org
Siver has conducted three separate audits for this client. Siver was engaged by Hillsborough County
to conduct an independent review of the Claims Settlement Process developed and managed by the
County. The audit included an overview of the process utilized by the County to resolve payment of
unprocessed health claims incurred prior to February 15, 2002. The settlement process was
generated in response to network providers who complained that numerous claims had not been
processed by the administrator for the County's indigent health plan from October 1, 2000, through
February 1 ~, 2002.
Siver Insurance Consultants (Siver) was subsequently engaged by Hillsborough County to conduct
an independent review of the new claims administration services provided by Administrative
Services, Inc. (AS)) in conjunction with the County's Indigent Health Care Plan. This audit included
an overview ofthe process utilized by ASI to adjudicate claims during the first half ofcalendar year
2003. This audit was concluded in September of 2003 and a similar audit was conducted in
September of 2004, covering the period subsequent to the 2003 audit.
CITY OF WINTER HASTEN
451 Third Street, NW
P. O. Box 2277
Vv inter Haven, FL 33883-2277
Ms. Michele Stayner
Community and Workforce Services Department Director
Tel.: (863) 291-5667
Fax: (863) 291-5623
Email: mstaynerra?~nvwinterhaven.com
At the request of the City of Winter Haven, Siver Insurance Consultants conducted an audit of the
Claims Administrative Services provided to the City by Blue Cross Blue Shield of Florida. The
scope of the audit project included a random review to confirm if claims from the first eight months
of 2003 were processed according to the City's benefit schedule. Additionally Siver's audit included
a targeted review of claims denied, to determine if covered services might have been excluded in
en-or or if claims were appropriately rejected for additional information. This audit was completed in
October of 2003.
CITY OF FORT PIERCE
100 North U.S. Highway One
P. O. Box 1480
Fort Pierce, FL 34954
Mr. George Bengalis
Director of Finance
Tel.: {772) 460.2200, ext. 332
Fax: (772) 489-2594
Does not utilize Email
Our most recent audit for this client was performed the week of February 7, 2005. This audit
included a review of medical, dental, and prescription drug claims for the plan year 2004. The final
results of this review of services provided by the Third Party Administrator, Employers Mutual, Inc.
are pending client review.
Siver has conducted aumerous audits for this client, including an audit of the City's prior TPA,
conducted in 2002.
LEE COUNTY SHERIFF'S OFFICE
14750 Six Mile Cypress Parkway
Fort Meyers, FL 33912-4406
?~~ir. George Mitar
Legal Director
Tel.: (941) 980-9994
Fax: {941) 477-1040
Siver Insurance Consultants (Siver) were engaged by the County of Lee Sheriff s Office to conduct
an independent audit of the Employee Benefit Plan administered by Hunt Insurance Croup, Inc.
The audit, conducted in May of 2002, covered claims adjudicated by Hunt and incurred from June
2000 through the end of October 2001.
MARTIN COUNTY SCHOOL BOARD
500 East Ocean Blvd.
Stuart, FL 34994
Ms. Julie Sessa
Employee Benefits Risk Manager
Tel.: (772) 219-1200 x.3020b
Fax: (772) 219-1226
Martin County School Boazd engaged Siver Insurance Consultants (Siver) in May of 2002, to
conduct an independent audit of the employer sponsored Employee Benefit PIan, administered by
CIGNA. The audit period included claims adjudicated by CIGNA for claims incurred from
:November of 2000 through the end of October of 2001. This audit was completed in August of 2002.
COLLIER COUNTY SHERIFF'S OFFICE
3301 Tamiami Trail East, Building J
Naples, FL 3411 Z
Ms. Carol GoIightly
Assistant Finance Director
Tel.: (239) 793-9230
Fax: (239) 793-9405
At the request of Collier County Sheriff s Office, Siver Insurance Consultants conducted athree-
phase review of the Group Health Plan and the Claims Administration Services provided to the
Sheriff's Office by Hunt Insurance Group, Inc. (Hunt), a division of Hilb, Rogal & Hobbs (HRH).
Thethree-phase scope of the project included a series of Focus Group Interviews with employees; a
comparison of the Group Health Plan offered by the Sheriffs Office to other Florida Group Health
Plans; and an nn-site claims audit at Hunt's offices to confirm if 2003 health claims werc processed
according to the Sheriff's Office Plan pazameters. The project was completed in July of 2004.
G: FEES
IMPORTA~~1T NOTE
While the Scope of Services indicates the audit was intended to include a review of 100% of tt~e
processed claims for medical, dental, hospitalization, and prescription drug claims, it is our
experience that the typical audit consists of a sampling of paid claims, rather than a 100% review,
The sample is randomly selected from a listing of all processed claims to determine if any significant
discrepancies exist. In the absence of significant discrepancies, a full claims audit is usually
unnecessary and would prove to be cost prohibitive.
Based on the population indicated for this group, Siver recommends an initial sampling of ~% or
approximately 400 claims. Our selection process would cover claims throughout the 12 month claim
period requested and would include samples from each of the categories indicated (medical, dental,
hospitalization and prescriptions).
Should the initial sampling reveal an error ratio in excess of industry standards, Siver would contact
the Village of North Palm Beach to detcrmine if an extended audit is desired.
With these comments in mind, Siver has offered a project estimate, based on review of an initial
sample consisting of 400 claims. Based on information obtained from Employer's Mutual lnc., 400
claims represents an audit sample of approximately 5% of the claims adjudicated during the audit
period indicated. A 5% audit is consistent with industry standazds.
To the extent that a larger audit is desired, we have provided our fee for each additional 100 claims
to be reviewed. We are available to discuss our fee structure and will provide adjusted estimates
based on other parameters, if desired.
- Auditor Rate:
- Technical & Administrative Support Rate:
- Travel & Business Expenses:
Estimated Cost
$150.00/Hour
$ 40.OO/Hour
Pass Through Basis to Client
First 400 Claims
- Each Additional 100 Claims Reviewed
> Travel & Business Expenses:
$ 7,500.00
$ 1,200.00
Pass Through Basis to CIient