abdi clear

Best in Class Consulting:

Group Health Plan Consulting & Actuarial Support Services

Learn about Advanced Benefit Design Institute, a leading healthcare actuarial consulting firm specializing in product pricing, cost containment, model building, data analysis, underwritting, strategic planning and business strategy

(Partnering opportunity for Group Health Brokerages, Benefit Consulting Firms, TPA's, and Benefit Professionals)

Read more



 

  • The Best Level Funded
    Self-Insured Deliverable

    Real strategy to reduce the number, size and frequency of claims of your company! Read More
  • Reference Based Pricing
    with Auditing Service

    Providing claim review and auditing services (Audit Program) to self-funded health plans (Plans) for Out of Network Claims or for Plans that have determined to not use a Network for access to medical services at hospitals to pay those claims. Read More
  • 100% Transparent
    PBM

    A fee-only PBM model and no additional margin gained from favorable tier placement on high-cost/revenue drugs. Read More
  • Best Claim Processing
    with ACA Compliance

    A technology company that specializes in providing outsourced administrative solutions to payers. Our primary objective is to increase productivity, efficiency, and profitability for all of our clients. Read More
  • Best Eligibility
    Enrollment & Admin

    Don't struggle with enrollment HRIS and benefits administration or managing your incentives. Let our automation perform these HR time-consuming tasks for you. Read More
  • Technology to Identify Gaps in Care

    Eliminating Gaps in Care will flatten renewals, improve productivity and reduce Disability and Worker's Comp Claims.
  • Tool to Calculate Bad Behavior Spending

    Delivering Financial Wellness Tools that lead to True Health to Wealth Solutions. Improves engagement and medical illiteracy. Nation's only behavior modification illustration tool. Read More
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7

Level Funding - Best Solution Available in the Country!

Reference Based Pricing with Auditing Service

Over 1,000 entities have attempted a Reference Based Pricing model. Most every one has been and is deficient or inadequate creating legal exposure and much stress and heartache to patients, plan sponsors/employers. There is much to be gained through a Reference Based Pricing vendor who can perform this duty comprehensively and as a fiduciary. There are only a couple Reference Based Pricing vendors in the United States that perform the needed process properly. Our recommended vendor is fully vetted and one of the successful Reference Based Pricing vendors.

The Audit Program is set up to recognize the Medical Provider’s actual cost to deliver the service and to allow a fair margin above that cost. The Audit Program does not use billed charges as a starting point.

Instead it utilizes transparent and recognized industry sources, with a particular focus on Medicare and the annual cost reports many Medical Providers report annually to the Centers for Medicare & Medicaid Services (CMS).

 - GUARANTEE -

If our fee eliminates a financial benefit for the plan on ANY claim, then ALL usual & customary vendor services on that claim will be FREE to the plan.

 - CASE STUDY -

SUMMARY

• Member treated at a hospital facility in central California
• Member was treated for chronic cholecystitis (chronic gallbladder issues common with recurring gall stones)
• Member received surgery which was charged at $15,825.44 (billed charges)
• Hospital facility then unbundled the same charges and billed them separately aka Unbundled Charges
• Total billed charges: $56,849.64
• Total Amount Plan Saved: $50,944.34

STUDY CONCLUSIONS

These are charges that never should have been included in the bill. We then reduced
the bill even further per its audit process in accordance with the Plan language, saving the Plan a total of
$50,944.34.

 

Contact us today

Ask a question
We Want to Talk to You Today!
Key Health Plans