URS Strategic Business Partners

                                                         Text Box: LivingWell Health Solutions is a Charlotte, NC based firm that brings years of experience in healthcare and wellness programs to reduce healthcare claims costs. With over 100 clients and over 50,000 employees participating, our track record of success can easily be applied to your organization. LWH Solutions offers healthcare clients a choice of programs designed to fit their specific needs and an opportunity to improve processes and help reduce claim payments. LWH Solutions is headed by a seasoned executive, Thomas R. Revels, with over 20 year’s healthcare management experience, including tenures as CEO for two major NC healthcare providers. A combination of years of healthcare experience and a proprietary methodology which incorporates downloads of claims data assure a quality wellness program for your organization. The program comes complete with a first year guarantee that a client will save more than the cost of the program or LWH pays the difference.                                                

 

                                                   

 

Text Box: Health Decisions, Inc. is a privately owned, Michigan Corporation founded in 1985. The firm specializes in post payment and enrollment data auditing services to group health benefit clients throughout the country. Enrollment Audits Dependent Eligibility Facts about dependents change. Often these changes go unreported or undetected. Typically 4%-12% of dependents enrolled in a group health plan no longer meet eligibility criteria. The Dependent Eligibility Audit confirms dependent status through the collection and review of required documentation. Enrollment Information Enrollee information changes in both small and significant ways. Over time these changes can accumulate to the point where they impact claim payment and regulatory compliance. The Enrollment Information Audit confirms all enrollment facts, corrects out-of-date or erroneous information, and gathers new information when needed. Employee Reconciliation It is not uncommon to have current or former employees incorrectly enrolled. In rare instances employers find that persons enrolled have never worked for them. The Employee Reconciliation Audit detects and documents enrollment error and potential fraud related to employees. Administrative Overpayment & Claim Recovery Audits Medical & RX Every health plan has waste (claims paid that should not have been paid) and abuse (actions taken that are inconsistent with Client interests). This audit provides a basis for: documenting waste and abuse levels with precision; exposing areas for potential fraud investigation; taking steps to recoup recoveries; and directing corrective action. Full service Audit Full Audit Services All Enrollment and Administrative Overpayment and Claim Recovery audits, along with added benefits from: more precise findings and fraud detection; additional recovery opportunities; minimal client time required for maximum results; and service pricing economies.                                                                                      

 

                

    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                                                           

 

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