ABOUT
QBA CONSULTING CORPORATION
QBA Consulting Corporation specializes in Quantitative Benefits Administration
audits, data analysis, and consulting on cost controls and program stewardship in
health benefits administration. QBA has the experience of auditing most of
major insurance carriers and third‑party administrators (“TPA”) in the
country.
While most other audit and consulting firms use
the traditional statistical sampling approach to claim audits, QBA takes a more
innovative and pragmatic approach. The survey audit and the electronic analysis
of 100% of the claim universe are the two steps that help focus on the broader
issue of controls over claim administration and other financial exposures to
the benefit plan. Rather than just providing statistical assurance that claims
are paid within an acceptable error rate, QBA identifies those claims that have
been overpaid, determines what caused the overpayments, and recommends the
establishment of controls and reporting system to minimize future errors. The
identification of actual overpaid claims makes it possible for the claims
administrator to recover and refund overpayments to the Plan through its normal
claim overpayment recovery process. The bottom-line result of the MARS analysis
represents the identification of actual overpayments in the claim universe
rather than an inferred projection of the estimated error.
Additionally, QBA’s audit effort is focused
towards identifying inefficiencies and weaknesses in claim administration that
provides opportunities for cost savings. Because of our specialization and
extensive experience, we are also able to provide suggestions for improving the
administration and stewardship of the Plan.
Rather than use a theoretical approach on how the administrator should
be performing; we evaluate, through the audit process, how well they are
performing. We identify mistakes in past performance, analyze the cause of
them, and provide recommendations for improving and controlling future
performance. QBA’s audits have resulted in millions of dollars in cost recoveries
and more in future cost savings. A QBA audit also provides management with a
stronger and more thorough basis for contract negotiations.
Specifically, QBA distinguishes itself from its
competitors by:
·
Audit Experience – QBA Consulting Corporation has performed over
160 health benefits administration audits for corporate, government and
non-profit organizations. This experience provides QBA with the industry knowledge
and other programs to make benchmark comparisons of your plans and its
administration to that of similar organizations.
·
Consulting Advice – Our audits are not leveraged to
less-experienced staff personnel. QBA
consultants have an average of 15 to 25 years experience in auditing and
consulting on health benefit administration and prescription drug programs. QBA
consultants provide effective, practical recommendations for improving Plan
administration, contracting, and claim processing controls.
·
Success of Proprietary Software - Due to the track record of the MARS system, it
has been our experience that the high rate of accuracy produced by the system
tends to reduce wasted audit effort and allow the audit staff to quickly focus
on the areas of greatest exposure. This focus has allowed most of QBA’s clients
to recover and discover savings, which exceeds the project cost. QBA's
electronic analysis of 100% of the claim universe will identify those overpaid
claims that have not been corrected and will provide positive assurance that
the majority of claims had not been overpaid.