Potential Prospects

Self-Funded Organizations that lack the knowledge or resources to audit the claims payment process.

The Opportunity

Defend yourself against the costly inaccuracies in claims processing. Benefit Watch reviews the entire claim process—from patient to provider to insurance carrier. When we’re done, you will have an effective action plan that eliminates waste and adds value to your bottom line, potentially recovering historical money owed.

Scenarios Where Benefit Watch Can Help

Late Payment Plans or Health Carriers
When carriers delay paying providers on a timely basis, the natural reaction of a physician is to re-submit the claim. When that happens, carriers can see multiple copies of the same claim, which can lead to expensive duplicate payments.

Individual Physician or Group
All individual physicians have an ID code, but whether your employees are seeing a true sole practitioner or a member of a large group, claims can easily be submitted by both individual doctors as well as by their associated group.

Outpatient Services
With outpatient service utilization on the rise, the billing from doctors for their services—and for their assistants—can become problematic. For example, the use of Certified Registered Nurse Anesthetists is on the rise by MD anesthesiologists, but you should not be required to pay equal charges for both.

Frequency of Service
How often should expensive medical diagnostics or lab procedures be repeated in a given period? You want your employees to have the best healthcare available, but at the same time, what are reasonable limits on how often the same test can be performed?

The AmWINS Advantage

Benefit Watch reviews 100% of your claims associated with your company’s medical benefits, including:
• Mechanical Duplicates
• Clinical Duplicates
• Self-funded Medicare GAP
• Procedural Duplicates
• Assistant Surgeon Overpayment
• Single Event
• Bi-lateral and Multiple Conditions

Ninety-six percent of Benefit Watch reviews result in an actionable outcome.

Benefits

• Cost recovery
• Error detection and irregularities
• Reduced future benefits spending
• ERISA and benefit plan compliance
• Utilization management improvements and information to better manage administrator
• Actionable information for strategic and financial planning
• Flexible options to meet your needs and requirements