ABOUT US
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.
Benefits:
- Mitigate liability for health plan trustees and administrators: ERISA is a federal law that sets standards for non-government private health plans to protect individuals participating in these plans (employees/members). Plan trustees and administrators have the fiduciary responsibility, obligation and liability to protect their members regardless of what their third-party payers do. Employees, former employees and stockholders can and do sue health plan administrators, managers and trustees for breach of fiduciary duty. US Beacon works for the trustee, administrators and employees/members to conduct compliance analysis review of medical claims $10,000. or higher. The compliance analysis review helps protect government and private plan administrators, managers and trustees from being accused of not protecting their employees and breach of fiduciary duty.
- While helping to protect the integrity of the plan trustees, managers and administrators, US Beacon historically lowers the overall expenditures of the health plan by approximately 6% to 10%. This cost savings can provide members with better health benefits at a lower cost.
- Monitor TPAs and Payers: The US Beacon compliance analysis review on behalf of the managers, members, trustees and administrators of the plan helps ensure that payers and TPAs are transparent and provides services that benefit the plan.
SERVICES
- US Beacon provides our clients with a real time 24/7 portal interface that allows for customizable reporting features and options for client data that is accumulated over the course of business. USB provides a secure portal system that is able to process claims individually or in a batch format. We provide access to designated client’s staff to be able to login to the secure software portal and upload related forms for claims.
- US Beacon conducts a forensic analysis for each field and line item with revenue codes prior to payment and the application of any deductions or fee schedule. We utilize the Universal Billing (UB) or Summary, the itemized statement, medical records, clinical/financial analysis, and other documents. US Beacon utilizes all available documents. If our client does not have a document or record from a provider that is needed, US Beacon obtains said document with no additional cost to our client.
- In addition to our proven Compliance Analysis Review for medical claims/bills, US Beacon’s Rx program will review and audit J-codes. Claims/bills containing HCPCS Level II J-codes are commonly used for chemotherapy, immunosuppressive drugs.
- All processes, communication, technology and procedures follow The Health Insurance Portability and Accountability Act (HIPPA) regulations.
