US Beacon (USB) conducts compliance analysis review of medical claims for corporate and government health care and workers compensation plans. The compliance review identifies ineligible charges along with fraud, waste and abuse issues that the plan’s TPA and/or carriers miss. The results save plans millions of dollars and provides their employees with a better health benefit at a much lower cost. On average, USB finds over 30% ineligible claims and savings on 99% of the claims they review. The effect to the total healthcare spends average 6% to 10% savings. There is no charge unless USB saves the plan money. USB provides the plan's trustees and administrators with transparency and control of their healthcare expenditures.
Any Medical Self-Funded Health and Workers Comp Plan
No, a third-party scope of work agreement (SOW) is executed. Most plans have their own SOW agreements that meet confidentiality and HIPPA requirements. The client can submit claims over $10,000 at their own discretion. Many of our clients start this way but end up submitting all claims over $10,000. They realize the transparency and control USB provides them to better manage their plan along with large savings for the plan and members.
US Beacon (USB) has saved clients up to 100% on claims/bills. On average USB saves their clients 30% to 40% on claims/bills over $10,000.
We accept claims/bills as small as $10,000 with no maximum.
Historically over $3 million. The following is an actual example for 12 months of savings for a self-funded plan consisting of approximately 15,000 members:
Total Bills Submitted - $11,962,976.
Adjusted amount paid - $8,256,472.
Gross Savings - $3,706,504.
Percentage of Savings 31%
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. The average savings is between 30% to 40%. USB has reviewed claims/bills that save the client up to 100%.
If USB does not save the plan, there is no charge. USB receives a percentage of established savings.
Two to four business days after USB receives the claims/bills and related documents.
USB averages less than 1/2 of 1% appeals rate. USB will handle the appeals process with the provider. If a claim or bill is appealed there is no fee paid to USB on the amount appealed.
USB will provide a free Compliance Review of 6 to 10 claims/bills at no charge. The claims/bills provided by the plan can be post or prepaid.
Explanation of an actual claim report after review by US Beacon. See the claim/bill report below.
Total Claim Amount: $314,997.21
Ineligible Amt: $94,665.90
Adjusted Claim Amt: $220,331.31