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

Services:

From eliminating abuse and waste to ensuring faster, more accurate claims processing, this valuable employer-friendly solution thoroughly reviews the entire claims process – from patient to provider to pharmacist to insurance carrier. The AmWINS Benefit Watch audit team then provides an effective action plan that eliminates waste and adds value to your client’s bottom line.

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

•

Pricing

•	Dispensing fees

•	Claims Basis

•	Claims Summary

•	Billing – drug cost

•	Billing – administrative fees

•	Co-payments

•	Exclusions

•	Eligibility

•	Scripts Filled Too Soon

•	Unsupported Therapy

•	Maximum Daily Dosing

Options that can help you take control of your pharmacy benefits:

•	AmWINS Check-up Our basic package of review services examines the major contractual elements, this option provides a clear view how well contract term have been implemented.

•	AmWINS Action In addition to our basic package of review services, AmWINS Action examines co-payment, utilization controls, billing, and reconcilitiaion.

•	AmWINS Complete Contains the complete set of AmWINS Action reviews along with an eligibility test.

•	AmWINS Part D Designed for the annual Part D compliance requirement and looks at LIS, Troop, co-payments, days supply limits, formulary compliance, deductibles, and maximum out-of-pocket calculations and exclusions.