Self-funded plan sponsors rely on cost management initiatives to reduce healthcare expenses and meet fiduciary responsibilities. Our program offers a single, comprehensive package of Medical and Pharmacy claims review, High Cost claim management, Dependent Eligibility verification and Billing Verification to retain more of your money in the future.

Why Choose Us?

• Outsourcing to a single, independent firm
• Expertise of 20+ years
• Ongoing reviews each year
• Unburdens Human Resources Staff
• PEPM Bundled Pricing, customizable
• Trusted by companies and Governments

Components

Medical Claims Review

• Non-sampling review (100% claims reviewed)
• Error detection and irregularities
• Reduce future spending through better management

Dependent Eligibility Review

• Performs a Summary Plan Description Analysis to uncover eligibility gaps
• Provides a One-Time Comprehensive Audit and Continuous Audits of Newly-Added Dependents
• All audits include Online Affidavit, Verification Documents, & Data Capture
• Technology-driven process quickly reveals eligibility outliers & anomalies

BILLING VERIFICATION

• Monthly detailed review of all components

PHARMACY CLAIMS REVIEW

• Non-sampling review (100% claims reviewed)
• Full pricing review and error impact
• Identify over-utilization issues

HIGH COST ACTIVITY

• Provides early notification of covered members with conditions/ diagnosis apt to hit or exceed stop loss specific deductible
• Clinical summary can be used to trigger referral to care management solution with contracted vendor and/or referral to Communitas for OnSIGHT Case Management
• Can provide estimated plan year and future plan year projected expenses which may be useful for favorable stop loss renewal and/or laser removal outcome

AmWINS’ blend of operational expertise, sophisticated analytics and bundled packaging provides clients with the greatest opportunity to maximize savings today and in the years ahead.