- Medical Claims are being paid properly – Discounts are being realized? Duplicate payments are not being made? Stop loss payments are accurate?
- Case management is working effectively?
- Disease management programs are optimized for members with various conditions, such as Diabetes?
- Claims are not being paid by both the health plan and the worker’s compensation plans?
- The pharmacy plan Is being administered consistently with the contract terms and plan design – Discounts are being realized? Rebates are accurate? Co-payments are accurate? Limits and exclusions are being enforced?
Since our solutions employ 100% of the data: census, enrollment, COBRA, medical claims, pharmacy claims and worker’s compensation claims (optional), our results are always more compelling than statistical audits performed by big HR consulting/brokerage firms and accounting firms. Moreover, we’re truly independent – we will do what’s right for the plan, not because of our relationship with the TPA, PBM or payor.
Contact us now to arrange for a demo.
