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About Trilogy

Providing Resources for Self-Funded Plan Administration Since 1995. Put Trilogy’s Expertise and Experience to Work for Your Organization.

Who We Are
Trilogy is a focused practice specializing in self-funded claims administration consulting and auditing. Trilogy is the only claims auditing firm which publishes guidelines used by claim payers for the administration of medical, dental and short term disability claims – The Trilogy Claims Administrative Handbook. Trilogy clients can be assured that Trilogy’s expertise includes knowledge of current and constantly changing regulations affecting self-funded claims administration because WE WROTE THE BOOK ON CLAIMS PROCESSING!
Why We Are Different
Trilogy professionals are not attorneys, accountants, IT consultants or benefit consultants who offer claim audits as “an add on” or “value added” feature to its offering of core services. Claims administration auditing and consulting IS Trilogy’s core business. Each Trilogy professional has no less than 20 years experience in claims administration operations and consulting. These professionals manage and staff our client’s claim administration audit projects. The one and only focus of our firm is claims administration quality.

Trilogy’s knowledge extends beyond just familiarity with regulations affecting self-funded administration. Due to our extensive experience as benefit professionals, each Trilogy consultant has an in-depth knowledge of the real operational issues affecting self-funded plans and their claim payers. Trilogy identifies opportunities for improvement which are timely and relevant to the environment in which self-funded claims are administered. Furthermore, Trilogy publishes The Trilogy Claims Administrative Handbook – a 2,200 page self-funded claim processing guideline resource which is updated on a quarterly basis. No other firm offering claim administration audit and consulting services also offers such a comprehensive publication.

Trilogy maintains a client retention rate exceeding 95% and multiple clients have retained the services of Trilogy for over 15 years. Trilogy works closely with its clients and their claim payers to improve the ongoing quality of claims administration through a process of retrospective review and evaluation. Annual claim administration audits performed by Trilogy include the evaluation of the claims payer in resolving ongoing issues including the monitoring and collection of overpaid claims. This type of audit methodology results in 100% of overpayments being returned to the client without the deduction of a “contingency” fee by the audit vendor.
Mission Statement
Trilogy Consulting Group’s mission is to promote the value of accurately adjudicated health care claims for its clients, the health plans administered by its clients and ultimately, the plan’s members. Trilogy will continuously strive to provide the best possible service to its clients and promote fair and accurate claim payment practices through performance of audits, publication of guidelines and completion of specialized consulting projects.