US Beacon (USB) is dedicated to conducting compliance analysis reviews of medical claims for both corporate and government healthcare plans, including workers’ compensation. Our primary goal is to uncover ineligible charges and billing errors that might be missed by the plan's Third-Party Administrators (TPAs) or carriers. USB has a track record of saving plans millions of dollars, enabling enhanced health benefits for employees at lower costs. We find errors on 99% of claims we review leading to an average reduction in total healthcare expenditures by 6% - 10%. On in-network bills, we save an average of 30%-40%. Out-of-network bills we average savings of over 60%. USB operates on a risk-free basis, charging fees only when we save you money. Our services provide increased transparency and control over healthcare spending for plan trustees and administrators.
Benefits:
• Risk Mitigation for Trustees and Administrators: USB's compliance analysis, safeguards plan trustees and administrators against liabilities under ERISA by ensuring fiduciary duties are upheld.
• Cost Savings: Historically, USB’s efforts have led to a 6% - 10% reduction in health plan expenditures, directly translating into more affordable, higher-quality benefits for members.
• Oversight of TPAs and Payers: Our reviews ensure that TPAs and payers are able to provide services in the best interest of the plan, the plans managers, members, trustees, and administrators.
Any Medical Self-Funded Health and Workers Comp Plan
USB conducts Compliance Analysis Review (CAR) for the plan on in-network and out-of-network medical claims $10,000 and larger. USB will review and provide a compliance analysis on claims after the health plan has processed and approved the claim establishing it ready for payment. USB averages 30%-40% additional savings for our clients on these claims. This savings is prior to any contractional arrangement, PPO, or fee schedule deductions. If USB does not find savings, there is no charge. USB receives a percentage of established savings,
24-48 hours after USB receives the UB04, itemized statement and EOB (explanation of benefits)
USB averages less than 1/2 of 1% appeals rate. USB will handle the appeals process with the provider.
Explanation of an actual claim report after a review by US Beacon.
See the claim report below.
30% savings
Total Claim Amount: $314,997.21
Ineligible Amt: $94,665.90
Adjusted Claim Amt: $220,331.31
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U.S. Communities, National IPA, & NCPA are wholly-owned subsidiaries of OMNIA Partners, dba OMNIA Partners, Public Sector. All public sector participants already registered with National IPA, U.S. Communities, or NCPA continue to have access to all contracts, with certain exceptions, in the portfolio and do not need to re-register to use a legacy National IPA, legacy U.S. Communities, legacy NCPA, or new OMNIA Partners contract. U.S. Communities, National IPA, and NCPA remain separate legal entities and lead agency contracts completed under each brand are effective and available for use through the contract’s approved term. In the event we believe re-registration is necessary for any reason, OMNIA Partners will let you know.
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