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AmWINS Group Benefits Launches Pharmacy Audit Tool for Employers
Warwick, RI – AmWINS Group Benefits, responding to costly and
rampant inaccuracies in claims processing, is today announcing a
new tool to protect businesses from the reporting errors that drive
up the price of health care for them and their employees. AmWINS
Group Benefits, a leading distributor of wholesale retiree and
employee health benefits and professional services, today launched
AmWINS Benefit Watch™. The software-based tool audits
prescription, medical and dental claims, to ensure that anything a
managed care organization or TPA is charging a client is accurate
and ordinary.
Millions of consumer dollars are wasted each year due to erroneous health care claims, a result of faulty IT systems, human error or premium benefit rules. Auditors have found that 3 to 5 percent of pharmacy benefit manager claims are processed incorrectly.
The implementation of an auditing process detects reporting errors and irregularities and ultimately stops the bleeding of dollars spent to cover exaggerated health care benefits. A thorough pharmacy audit program, such as AmWINS Benefit Watch™, will identify the plausible issue, support the refund negotiation process and assist in preventing future mistakes.
“Drug costs are increasing in double digits annually and are one of the fastest growing components of rising health care costs. Steps must be taken to control costs and preserve quality,” said Sam Fleet, AmWINS Group Benefits President and CEO. “Companies should start recognizing the value pharmacy audits bring to both the cost and quality of pharmacy benefits,” Fleet added.
While 80 percent of health care spending is in the area of medical services, some experts attribute a significant part of that to erroneous medical claims. Claims trends over the last decade have brought about new issues. Some are a function of the claims process, while others are related to trends in the delivery of health care.
“Recent flaws in reporting benefits have gained a lot of attention,” said Mark Lawlor, AmWINS Group Benefits Vice President. “Our goal is to prevent situations where the late payment by carriers results in physician re-submitted claims that become duplicate paid claim errors.
Lawlor added that, “our goal is to prevent the financial cataclysm of one patient having six colonoscopies in one week; which was really one colonoscopy and five consulting opinions.” AmWINS Benefit Watch™ is designed to prevent errors and irregularities and help companies get their money back when mistakes are made.
Benefit Watch™ prevents errors by conducting medical reviews for, among other things, duplicates and overpayments. Unlike many other pharmacy review services, the complete AmWINS Benefit Watch™ package also covers many categories of pharmacy review including pricing review, co-payment review, eligibility review, excess daily use review, and exclusions review.
AmWINS Benefit Watch™ examines critical aspects of health benefits to determine if:
• All claims are being processed correctly according to contract and benefit terms
• All fees are being charged correctly
• Any claims appear irregular and heed further investigation
###
Millions of consumer dollars are wasted each year due to erroneous health care claims, a result of faulty IT systems, human error or premium benefit rules. Auditors have found that 3 to 5 percent of pharmacy benefit manager claims are processed incorrectly.
The implementation of an auditing process detects reporting errors and irregularities and ultimately stops the bleeding of dollars spent to cover exaggerated health care benefits. A thorough pharmacy audit program, such as AmWINS Benefit Watch™, will identify the plausible issue, support the refund negotiation process and assist in preventing future mistakes.
“Drug costs are increasing in double digits annually and are one of the fastest growing components of rising health care costs. Steps must be taken to control costs and preserve quality,” said Sam Fleet, AmWINS Group Benefits President and CEO. “Companies should start recognizing the value pharmacy audits bring to both the cost and quality of pharmacy benefits,” Fleet added.
While 80 percent of health care spending is in the area of medical services, some experts attribute a significant part of that to erroneous medical claims. Claims trends over the last decade have brought about new issues. Some are a function of the claims process, while others are related to trends in the delivery of health care.
“Recent flaws in reporting benefits have gained a lot of attention,” said Mark Lawlor, AmWINS Group Benefits Vice President. “Our goal is to prevent situations where the late payment by carriers results in physician re-submitted claims that become duplicate paid claim errors.
Lawlor added that, “our goal is to prevent the financial cataclysm of one patient having six colonoscopies in one week; which was really one colonoscopy and five consulting opinions.” AmWINS Benefit Watch™ is designed to prevent errors and irregularities and help companies get their money back when mistakes are made.
Benefit Watch™ prevents errors by conducting medical reviews for, among other things, duplicates and overpayments. Unlike many other pharmacy review services, the complete AmWINS Benefit Watch™ package also covers many categories of pharmacy review including pricing review, co-payment review, eligibility review, excess daily use review, and exclusions review.
AmWINS Benefit Watch™ examines critical aspects of health benefits to determine if:
• All claims are being processed correctly according to contract and benefit terms
• All fees are being charged correctly
• Any claims appear irregular and heed further investigation
###