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Audits flag parity documentation gaps and processing errors; CTI urges further review and an off‑cycle audit for WellPoint
Summary
CTI’s preliminary mental‑health parity audit identified potential non‑quantitative treatment‑limitation (NQTL) and co‑payment discrepancies across GIC plans; a separate claims audit found operational and payment errors at WellPoint, prompting recommendations for focused carrier analysis, contract remedies, and an off‑cycle audit.
CTI presented preliminary findings from two audits of Group Insurance Commission (GIC) health plans, identifying potential mental‑health parity documentation issues across carriers and payment errors that prompted a recommendation for additional oversight of WellPoint.
Marie Pollock, director of medical audits at CTI, told commissioners the MHPAEA (Mental Health Parity and Addiction Equity Act) comparative analyses for fiscal year 2024 flagged common concerns across the four plans. ‘‘We identified co‑payment differences for outpatient mental‑health and substance‑use tiers and several quantitative limits—nutritional counseling, physical therapy, occupational therapy, and smoking‑cessation visits—that merit further review,’’ Pollock said.
Pollock noted four recurring NQTL areas…
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