State Employee Health Benefit Plan Audit Services

This RFP seeks a qualified vendor to provide comprehensive audit services for the State Employee Health Benefit Plan (SEHP) for the government authority located in Topeka, Kansas. The selected audit team must be available for both telephone and on-site consultations with SEHP as required and devote sufficient time to ensure a thorough review.

Key audit areas include Medical and Dental Claims, where the vendor is expected to document, evaluate, and comment on administrative procedures, the accuracy of plan provision applications, coordination of benefits with other coverage, accuracy and timeliness of claims payments and membership processing, and the vendor’s compliance with performance guarantees. Additional services required include the audits of the Pharmacy Benefit Manager, Dependent Eligibility Verification, and Premium Payroll Deduction Reconciliation.

The audit aims to support transparency, effectiveness, and compliance within the state’s health benefit programs, emphasizing accuracy, timeliness, and adherence to administrative standards.