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 overlooks. 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 8% to 10% savings. There is no charge unless USB saves the plan money. There is no risk or cost to the plan unless they save money. USB provides plan trustees and administrators with their own way of taking control and transparency of their health care spend.Benefits
- Mitigate liability for health plan trustees and administrators: ERISA is a federal law that sets standards for private industry health plans to protect individuals participating in these plans (employees/members). Plan trustees and administrator have the fiduciary responsibility obligation and liability to protect their members regardless of what their third-party payers do. Employees and former employees 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 trustees, administrators and managers from being accused of not protecting their employees and breach of fiduciary duty.
- While helping to protect the integrity of the plans trustees, managers and administrators, US Beacon historically lowers the overall cost of the health plan by approximately 8% 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 providing services that benefit the plan not just the carrier.
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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