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:
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 audits performed 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:
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.
“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 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:
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.
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:
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.
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.