Audit Services

Providing audit services for fully-insured and self-funded employers.

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Our audit services has helped employers identify and eliminate millions of dollars in inappropriate and wasteful spending. We offer audit programs for fully-insured and self-funded organizations, including dependent eligibility audits, medical audit services, and pharmacy audit services. 

 

Dependent Eligibility Audits

Most dependent eligibility audit firms typically have a one-dimensional approach to the dependent eligibility verification process. They just collect proof documents. Expert Audit® is a new, online approach to dependent eligibility audits that delivers optimal results with the best value.

Expert Audit® utilizes three steps:

  • An affidavit is completed by the employee
  • The employee submits proof documents to verify statements made in the affidavit
  • The employee must provide added data regarding his or her particular family situation

 

Medical Audit Service

Defend yourself against the costly inaccuracies in claims processing. AmWINS Benefit Watch® reviews the entire claim process – from patient to provider to insurance carrier. When we’re done, you will have an effective action plan that eliminates waste and adds value to your bottom line, potentially recovering historical money owed.

Benefit Watch® reviews 100% of your claims associated with your company’s medical benefits, including:

  • Mechanical duplicates
  • Clinical and procedural duplicates
  • Self-funded Medicare gap
  • Assistant surgeon overpayment
  • Single event
  • Bi-lateral and multiple conditions
  • Procedural rate variations

 

Pharmacy Audit Service

Ballooning pharmacy costs combined with consistent upward trends in usage can impact your ability to grow and stay competitive. Benefit Watch delivers the expertise to control the complex web of therapies, pharmacists, pharmacy benefits and pharmacy benefit managers.

Benefit Watch® reviews 100% of your claims associated with your company’s medical benefits, including:

  • Pricing
  • Fees (dispensing, claim, administrative)
  • Claims basis determination
  • Claims summary
  • Billing – drug cost and fees
  • Co-payments
  • Exclusions
  • Eligibility
  • Scripts filled too soon
  • Unsupported therapy
  • Maximum daily dosing