AmWINS Benefit Watch

Business Problem:

As managing medical benefits becomes more complex, few companies are equipped to monitor costly inaccuracies in claims processing. That’s why you’ll appreciate AmWINS Benefit Watch, which is designed to help you quickly identify budget-draining inefficiencies.

Now your clients will be able to detect whether employees are misusing their benefits and ensure that managed care companies and Third Party Administrators are charging accurately. From eliminating waste to ensuring faster, more accurate claims processing, this valuable employer-friendly solution thoroughly reviews the entire claims process – from patient to provider to insurance carrier. The AmWINS Benefit Watch audit team then provides you with an effective action plan that eliminates waste and adds value to your bottom line.

Potential Clients:

•	Employers with at least 1,000 employees

•	Government Agencies

•	Taft-Hartley plans

•	Third Party Administrators

•	Associations

•	Insurance Companies/Health Care Plans

•	Any payor of prescription drug or medical benefits

AmWINS Benefit Watch reviews 100% of claims associated with a companies medical benefits, including:

•	Mechanical Duplicates

•	Clinical Duplicates

•	Claims Basis

•	Procedural Duplicates

•	Assistant Surgeon Overpayment

•	Single Event

•	Bi-lateral & Multiple Conditions

•	Mutually Exclusive Codes

•	Non-Specific Codes

•	Eligibility

•	Paid-in-Excess of Charges

•	Prepaid Leakage

Scenarios where AmWINS Benefit Watch can help:

•	Late Paying Plans or Health Carriers When carriers delay paying providers on a timely basis, the natural reaction of a physician is to re-submit the claim. When that happens, carriers can see multiple copies of the same claim, which can lead to expensive duplicate payments.

•	Individual Physician or Group All individual physicians have an ID code, but whether your employees are seeing a true sole-practitioner or a member of a large group, claims can easily be submitted by both individual doctors as well as by their associated group.

•

Outpatient Services
With outpatient service utilization on the rise, the billing from doctors for their services – and for their assistants – can become problematic. For example, the use of Certified Registered Nurse Anesthetists is on the rise by MD anesthesiologists, but you should not be required to pay equal charges for both.

•	Frequency of Service How often should expensive medical diagnostics or lab procedures be repeated in a given period? You want your employees to have the best healthcare available, but at the same time, what are reasonable limits on how often the same test can be performed?