Paracon's end to end Risk Advisory approach reviews your entire health care Benefits supply chain

U.S. HEALTHCARE SPENDING ON TRACK TO EXCEED $10,000 PER PERSON IN 2016.  Let that sink in. With the National Healthcare Expenditure projected to be $3.207 trillion in 2015 and with the US population of about 320 million that is $10,000 per person. An alarming portion of your company’s healthcare spend is mired in a supply chain filled with fraud, waste and abuse.   

Paracon Group continues to develop unique and impactful solutions for our clients. We are NOT a firm that offers commodity Claim Audits. Our holistic approach to reviewing the entire Supply Chain of your company’s Self-Funded Health Plan goes far beyond what those other firms offer. Using our advanced analytics and artificial intelligence technology platform, EXPERTOOL, we discover anomalies in data AND information that other technology cannot. Our Risk Advisory approach, technology and expertise enables you to focus on making the most strategic and evidenced based decisions for one of your largest expenditures.

The Vendor and Supply Chain audit focuses on analyzing the business processes, both internally and externally looking for synergies, transformation, and cost saving opportunities between the many 3rd party vendors you’ve engaged. Prepayment Compliance reviews ensure all of your larger hospital claims are paid correctly before any funds leave your company. Our Plan Compliance ERISA audits give you the most comprehensive audit of your fiduciary responsibilities. Our Auxiliary Services cover audits of specialized areas such as Retroactive Provider Billing Compliance, Dependent Eligibility Verification, Pharmacy Benefits, Workers Compensation and Blue Card Audits. With the increased DOL and IRS focus on health benefit plans, many clients request a DOL Readiness Review. 


EXPERTOOL Innovation Framework

Paracon has developed technology and a methodology that has proven results.  We are not your average firm looking to perform a “Claims Audit”, rather we want you to make transparent, evidenced based decisions on how and where your monies are spent.

Why a Simulation Model of your plan data is important

Healthcare data coupled with plan design and 3rd party vendors has “complexity” written all over it.  The EXPERTOOL team has evolved the software and methodology to respond to real world complexity challenges and to address the limitations of available technology.  We know of no other firm that uses artificial intelligence simulation modeling to review claim data.  

 


PREPAYMENT COMPLIANCE REVIEWS

Medical billing is complex with  higher cost claims even more mistake prone. At Paracon we believe that continuous monitoring controls can assist in controlling your benefit costs.  Our holistic approach to reviewing the entire Supply Chain starts when the claim first is presented to your third party administrator (TPA). EXPERTOOL, enables us to discover anomalies in the prepayment claim data AND powers our experts to find those non compliant charges that no other firm can.   Not even your TPA has this amount of horsepower behind it.

It is a proven fact that hospital bills have errors. The last AMA survey noted that 20% of all healthcare claims are processed incorrectly Why pay for these errors when Paracon can review your bills before they’re invoiced to you? Our proprietary technology and auditing methodology evaluates charges to ensure compliance with federal billing regulations. We work with your TPA to put the necessary payment and compliance controls in place to save you money.

Our focus is on billing accuracy and fair pricing.  We average between 10-20% in savings for our clients.  


PLAN COMPLIANCE ERISA AUDITS

Plan Compliance ERISA audits are effective at helping self-funded plans control wasteful spending, and can also identify errors so they can be prevented in the future. When regular audits are performed, benefit administrators know that plans are serious about operating efficiently, maximizing performance, and minimizing wasteful spending. Additionally, conducting these reviews result in more effective plan management and future savings. A Plan Compliance audit proves to stakeholders and taxpayers that the plan is meeting its fiduciary responsibility to have appropriate financial controls in place.


VENDOR AND SUPPLY CHAIN AUDIT

Our Vendor and Supply Chain Audit focuses on analyzing the business processes, both internally and externally, while looking for synergies, transformation, and cost saving opportunities. The goal of our work is to evaluate, give alternatives and educate your team to the real issues and cost options that brokers and sellers of component health products cannot, exposing areas for important decision making and cost control.   

Some of the topics we will cover:

  • Breaking down your total expenditure for Health Coverage including all fees and commissions
  • Illustrating how many entities you are paying for management of your Health Plan looking for any overlaps.
  • Determining if you are receiving all of the services that you contracted for
  • Evaluating the role of your internal management of your Health Plan?  Could it be more cost effective to do more, or less?
  • Are you paying "double commissions" and "hidden fees" to your brokers, TPA's and agents?
  • How does your TPA agreement stack up industrywide?
  • Is your TPA agreement compliant with ERISA and ACA?

 


Retroactive Provider Billing Compliance

The retroactive compliance review of provider billing focuses on payment guidelines and policies including procedures, CPT coding, modifiers, typically for anesthesia, observation, and readmission claims.  Once identified and settled with the provider, our team will recover the monies due the plan.

Through data science and artificial intelligence built into EXPERTOOL, Paracon is able review your claims data from a uniquely different perspective, uncovering statistical significant outliers and patterns that are routinely missed through traditional algorithms. Paracon’s auditors, technology specialists and scientists will investigate these patterns to uncover overpayments, fraud and overspending that would otherwise go undetected. 

 


DEPENDENT ELIGIBILITY VERIFICATION

On average, between 4% and 8% of the dependents on your plan are not eligible for coverage. With Dependent Eligibility Verification, Paracon can uncover these hidden costs, delivering a typical return on investment of between 400% and 1,000%.  Let’s face it. Some dependents on your plan do not meet the eligibility criteria. This can be a huge financial drain. A verification will reveal the ineligible dependents which will reduce your spending and directly increase your net profitability. Dependent Eligibility Verification is a simple solution to this complex issue, ensuring that every dependent covered is actually eligible for coverage.

 

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