Audit reveals UMR's improved claims processing for Nevada Public Employees Benefits Program

In a recent meeting of the Public Employees Benefits Program (PEBP) Board held on May 22, 2025, significant changes were approved that aim to enhance healthcare coverage for male employees at risk of breast cancer. The board discussed aligning imaging procedures for men aged 30 and above with existing guidelines for women, allowing doctors to request necessary imaging based on individual risk factors. This decision is expected to streamline the prior authorization process, making it easier for healthcare providers to secure necessary tests for their patients.

The board also addressed the results of an audit conducted by Claim Technologies Incorporated (CTI) on claims processed by UMR for the last quarter of 2024. The audit revealed that UMR had improved its performance in terms of financial accuracy and claim turnaround times. Approximately $68 million in medical and dental claims were processed, with all performance guarantees met, indicating a positive trend in claims management. However, the audit did identify a couple of errors, prompting recommendations for further improvements, including the implementation of a prior authorization requirement for a specific drug due to its need for close medical monitoring.

Additionally, the board discussed upcoming legislative bills that could impact the Public Employees Benefits Program. These discussions are crucial as they could shape the future of benefits provided to public employees in Nevada.

Overall, the meeting highlighted the board's commitment to improving healthcare access and efficiency for public employees, addressing both immediate needs and long-term goals in benefits management. As these changes take effect, they are expected to have a direct positive impact on the health and well-being of Nevada's public workforce.