Trilogy offers specialized services to self-funded corporate employers,
health and welfare trust funds and government benefit plans, for the independent,
objective assessments of a plan's internal claims administration performance or
the performance of an external claim administrator.

Common mistakes in the administration of a self-funded health plan may include the following:

• Incorrect deductible, coinsurance and/or copayment application;
• Incorrect PPO discount application;
• Overlooked case management contracted discounts or;
• Incorrect application of precertification penalties;
• Incorrectly programmed benefits;
• Data entry errors;
• Payment of duplicate or noncovered expenses;
• Lax investigation for other insurance, workers compensation coverage, subrogation opportunities, third party liability or primary Medicare coverage;
• Inaccurate refund processing;
• Incorrect calculation of secondary benefits; or
• Paying upcoded or unbundled claims.

Underpayments due to these mistakes will cost the plan additional claims administration dollars. Overpayments due to these mistakes are seldom reported and cost the plan direct benefit dollars.

The best way to fully evaluate the quality of plan administration and to determine if the above mistakes are costing the plan precious benefit dollars, is through the performance of a comprehensive claims administration audit performed by an established, independent audit firm. Trilogy Consulting Group, Inc. is that firm.

The Sarbane-Oxley Act of 2002 requires auditor independence and management responsibility for internal audit controls. Independent and objective third party health plan audits outsourced to Trilogy Consulting Group, Inc. ensures compliance with this Act.

Benefit management reviews performed by Trilogy Consulting Group, Inc. can:

• Identify if an organization is providing accurate, cost-effective administration while maximizing the value of total benefit dollars and maintaining a high level of customer service to members of the plan,
• Assist employers and plan fiduciaries in monitoring their plan expenditures,
• Provide tools to measure any organization's claim administration performance against its own internal standards as well as industry best practices, and
• Establish claim administration performance benchmarks and monitor claim administration performance against benchmarks.

Benefit management reviews are tailored to the plan's objectives and performed by benefit professionals with extensive claim administration backgrounds. Recommendations to improve claims administration are relevant to the organization's claim processing environment while containing costs to the plan.

For more information or to request a proposal, contact us by telephone at (630) 953-6278 or by e-mail at kmartin-smith@trilogy-consulting.com or at bbaldwin@trilogy-consulting.com