I I I I I Audit Report I Delta Dental Insurance Company I January 1, 2013 - December 31, 2013 I I I I I I I Prepared Under Contract With: MONTANA LEGISLATIVE BRANCH, AUDIT DIVISION PO Box 201705, Helena MT 59620-1705 COMPREHENSIVE CLAIMS ADMINISTRATION AUDIT EXECUTIVE SUMMARY State of Montana Administered by: Delta Dental Insurance Company Audit Period: January 1, 2013 to December 31, 2013 Presented to: State of Montana April 14, 2014 Private and Confidential Presented by: Claim Technologies Incorporated Preface This Executive Summary consolidates important findings from each of the four separate components of Claim Technologies Incorporated’s (CTI’s) comprehensive audit of Delta Dental Insurance Company’s (Delta Dental’s) claims administration of the State of Montana (the State’s) self insured Dental plans. The information in this report is confidential and intended for the sole use of the Montana legislature, the State of Montana, Delta Dental, and CTI in their efforts to serve the interests of the plan participants of the State of Montana Dental Plans. This report is based on data and information provided to CTI by State of Montana and Delta Dental. CTI's compilations and findings rely upon the accuracy and completeness of that information and the samplings taken from it. CTI is a firm specializing in audit and control of health plan claims administration. Accordingly, the statements made by CTI relate narrowly and specifically to the overall efficacy of Delta Dental’s claims process and systems and to the accuracy and validity of State of Montana’s paid claims during the audit period. We conducted our audit in accordance with standards and procedures generally accepted and in common practice for Dental plan claims audits in the insurance industry of the United States. No copies of this document may be made without the express, written consent of State of Montana, which commissioned its compilation. CLAIM TECHNOLOGIES INCORPORATED April 2014 i Table of Contents Page Key Findings ................................................................................................................ 1 Comprehensive Audit Methodology .......................................................................... 3 - Objectives ....................................................................................................... 2 - Scope .............................................................................................................. 2 Audit Results ............................................................................................................... 3 - Operational Review ....................................................................................... 3 - Plan Documentation Review ........................................................................ 5 - Electronic Screening ..................................................................................... 6 - Random Sample Audit .................................................................................. 7 Summary of Recommendations............................................................................... 10 Exhibits: A. Performance Measurements and Benchmarking ................................. A-1 B. Prioritization of Errors and Savings Opportunities .............................. B-1 C. Key Performance Indicators and Operational Definitions ................... C-1 ii