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Clients & Projects

Employer Groups

HealthCare Analytic's Past & Current Projects for Employer Groups include:

    • Claims audits, to meet the following objectives:
      1. Claims paid and charged to the Group were on behalf of active, covered members
      2. Payments to providers were made consistent with the requirements of underlying contracts
      3. The appropriate liable parties were determined based upon the Group's subscriber agreement (was the service covered, were deductibles and coinsurance amounts properly determined and billed), site of occurrence or nature of the claim (subrogation, worker's compensation, etc.)
    • Due Diligence assessments for operational viability, administrative capacity, contracting capabilities, value added services of potential merger partners
    • Information System Development for tracking program outcomes and effectiveness
    • Statistical and Financial Analysis of cost and utilization data for rate evaluations, trend development and premium reconciliation
    • Product development and pricing for self-insured plan development
    • Development and assessment of RFPs for self-insured plans
 
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