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 are not equipped to identify. 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. In many cases USB finds savings that exceed 80%. The effect to the plan’s total healthcare expenditures average 6% to 10% savings. There is no charge unless USB saves the plan money. USB helps provide the plan managers, trustees and administrators with transparency and control of their healthcare expenditures.Benefits
- Mitigate liability for health plan managers, 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 managers, trustees and administrator 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 managers, 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 cost 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 members, trustees, administrators and managers of the plan helps ensure that payers and TPAs are transparent and provid services that benefit the plan.
- US Beacon ensures accurate and fair pricing for our client’s health plans and their providers resulting in significantly lower overall healthcare spend for the plans and members prior to actual payment of the claims/bills.
- US Beacon has become an intricate part of providing proven solutions for lowering client healthcare spend. For more than 30 years USB’s principals have provided our clients and the healthcare arena with savings on medical claims and bills.
- US Beacon is a proven leader providing our clients with a complete menu of cost containment solutions through a unique business model by utilizing a combination of artificial intelligence and hands on human review.
- US Beacon is easy to integrate with any plan’s current payer or TPA. Most importantly, USB will be working independently for our clients, the health plan, and their members by performing an independent third-party review and analysis of all our clients claims/bills, thus providing a substantial incremental saving and a new revenue stream.
Compliance and Cost Containment Strategy and Management of Healthcare Costs
Region 14 ESC
3 year term, September 1, 2022 to September 30, 2025
*Option to renew for two (2) additional one (1) year periods.
Request for Proposal:
RFP for Compliance and Cost Containment Strategy and Management of Healthcare Costs
Awarded Vendor Response:
US Beacon's Response to RFP
Bid Tab & Request for RFP List
Region 14 Award Letter
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