Health & Welfare Consulting
Denver Management Advisors, Inc. (DMA) is a leading provider of health care consulting and audit services, specializing in cost containment strategies, underwriting and financial planning. DMA is a trusted health insurance industry advisor providing consulting services to a wide range of employers, including private and public companies, self-funded employers, consultants/brokers, as well as Taft Hartley union trusts and third party administrators (TPAs). DMA conducts proactive claims audits designed to ensure that carriers are utilizing industry standard billing practices in their respective area of claim administration.
Health & Welfare Consulting Services
- Development of strategic planning document
- IBNR calculations
- Stop Loss insurance negotiations
- Financial analysis and reporting
- Issuance of Request for Proposal (RFP) and Request for Information (RFI), including negotiations and implementation oversight
- Compliance Review (ERISA, HIPAA, FMLA, 5500s)
- Large claims analysis
- Trend analysis
- Provider discount evaluation
- Provider disruption analysis
- Data Warehouse
- Wellness Program development
- HMO analysis to determine viability as a group product offering
- Open enrollment services
Audit/Consulting Services
- Health and Welfare Plan Audits in the following areas:
- Medical
- Dental
- Pharmacy (Pharmacy Benefit Manager (PBM))
- Eligibility
- Dependent Eligibility
- Claim Audits for Processing Accuracy
- DMA reviews 100% of paid claims using a combination of electronic analysis and expert clinical review to identify incorrectly processed claims.
- Enrollment Audit
- DMA performs an electronic comparison of the employer’s human resource/payroll/TPA system information to the respective health carrier eligibility and claim information to identify gaps in eligibility information that can result in retrospective recovery and future claim costs savings.
- Report findings and provide complete inventory of recoverable claims
- Provide recommendation to improve carrier/TPA efficiency and lower medical claims costs going forward
- Pursue collection of identified overpayments on behalf of employer