Trilogy Excess Loss Audit Services
Trilogy provides excess loss audit services to nationally and internationally recognized reinsurers, carriers and managing general underwriters (MGU). Trilogy's excess loss audit expertise combined with proven audit methodologies result in maximum savings at the lowest possible cost.
Trilogy audits may be performed remotely through the use of secure online connections to the administrator’s system. Trilogy is able to enter into remote user agreements to facilitate this process. Trilogy also maintains a HIPAA secured site through which large amounts of claims data can be exchanged securely. Claim audits performed remotely result in significant savings on travel expenses.
Aggregate Excess Loss Claim Audits
Aggregate claim audits may be performed remotely or on-site at the claim administrator's office. Trilogy can customize an audit to best meet the needs and budget of the reinsurer, carrier or MGU. Aggregate claim audits performed by Trilogy include the following components:
- Review of proof of loss and all supporting documentation used to substantiate the request for reimbursement;
- Verification of the aggregate request for reimbursement calculation;
- Ensure all payments for which reimbursement is being requested are eligible under the terms of the excess loss policy;
- Assess the accuracy of reports used to substantiate the request for reimbursement; and
- Verification of the accuracy of claims processing on claims included in the aggregate request for reimbursement.
Trilogy will provide the client with a concise report which details the audit findings. The audit report explains the differences between the amount of reimbursement requested on behalf of the group and the amount of reimbursement recommended by Trilogy.
Aggregate audits performed by Trilogy identify all issues affecting the aggregate reimbursement while retaining a positive relationship between the client, administrator and self-funded group.
Contact Trilogy for more information regarding its aggregate audit capabilities.
“Trilogy consultants are very knowledgeable regarding claims paying processes and adapt easily to the many different claim paying systems of our TPA partners.”
Vice President of Claims, Managing General Underwriter
Level Funded Reconciliation Audit Services
Level funded reconciliation audits performed during the policy period and/or reconciled at the conclusion of the policy period may be performed remotely or on-site at the claim administrator's office. Level funded reconciliation audits performed by Trilogy include the following components:
- Review of proof of loss and all supporting documentation used to substantiate the final request for reimbursement;
- Verification of the request for reimbursement calculation;
- Verification of monthly accommodation payments made to date;
- Assessment of the accuracy of reports used to substantiate the request for reimbursement;
- Calculation of the policy’s attachment point;
- Determine if any voids, refunds, pharmacy claim payment adjustments, pharmacy vendor rebates or outstanding overpayments should be deducted from the reimbursement calculation at year end; and
- Ensure all payments for which reimbursement is being requested are eligible under the terms of the excess loss policy.
For mid-year filing audits, Trilogy will provide the client with a detailed spreadsheet report explaining the audit findings and the differences between the amount of reimbursement requested on behalf of the group and the amount of reimbursement recommended by Trilogy. For year-end filings, Trilogy will provide the detailed spreadsheet as well as a concise report detailing the audit findings.
“Trilogy staff members exhibit expertise in problem solving, communicate well with others, work well under pressure and have the ability to make difficult decisions. Reports delivered by Trilogy are well written, concise and explain audit findings clearly.”
President, Excess Loss Carrier
Specific Claim Audits
Specific claim audits do not need to be performed in an administrator’s office. Trilogy maintains a HIPAA secured site through which large amounts of claims data can be exchanged securely and easily. Specific claim audits performed by experienced Trilogy staff, in Trilogy’s offices, result in significant travel time and expense savings.
Specific claim audits performed by Trilogy focus on the following areas of review:
- Other insurance investigation,
- Accident and third party liability,
- Large case management,
- PPO savings,
- Duplicate payments,
- Application of plan limitations and exclusions, and
Reinsurers, carriers and MGUs may customize the methodology used by Trilogy to audit specific claims to maximize savings and minimize audit expenses
Contact Trilogy for more information regarding its specific claim audit capabilities.
MGU Claim Administration Operational Reviews
Trilogy specializes in the performance of MGU claim administration operational reviews. MGU reviews are performed on-site at the MGU office and include the following components:
- Operational review including the completion of an extensive excess loss claims administration questionnaire, interviews with key personnel and review of the excess loss claims processing system capabilities;
- Review of large dollar specific and aggregate claims focusing on reimbursements just below the MGU authority dollar limit;
- Review of denied claims to determine if denials are appropriate and meet the carrier's denial criteria, and
- Reiew of potential claim notifications which do or do not have a reserve.
Findings from the MGU review are detailed in a comprehensive report providing a comparison to industry best practices and an action plan for improved service to the carrier and the group.
Contact Trilogy for more information regarding its MGU claim administration operational review capabilities.