Employee Benefit Professionals & Consultants
Seneca Risk Consulting Group, LLC
Affordable Care Act Consulting
The Seneca Group will evaluate, track employee work hours to ensure continued compliance with employer-shared savings responsibility under health care reform.
Pharmacy Claims Auditing
Prescription drug costs have risen steadly in recent years, and is fast approaching 30% of health plan costs. Are you sure that you are receiving the Average Wholsale Price (AWP) discount guarantees, and manufacturer rebate guarantees?
Medical Claims Auditing
Seneca Consulting Group provides detailed comprehensive healthcare claims audits to self-insured employers and labor orgainizations, with a focus on identifying and recovering overpayments.
Dependent Eligibility Verification
Every health plan is paying claims for ineligible dependents. Based on our experience, approximately 2%-6% of dependents are ineligible for coverage for a variety of reasons – divorces, non-biological children, domestic partners, etc.
Employee Benefit Consulting Services
Employee Benefit Consulting Services provided to Self-insured employers, School Districts and Local Government employers.
You Can’t Manage What You Can’t Measure
At Seneca Consulting Group, we believe that “you can’t manage what you can’t measure.” This belief is echoed throughout our approach to benefits consulting. We have pioneered a new process in benefits consulting that we call Audit-Based Consulting. Audit-Based Consulting leverages uses technology to ensure vendor compliance with service agreements and financial guarantees. Seneca Consulting Group’s Audit-Based Consulting services include the following types of data management and analysis:
- PPACA Compliance Auditing
- Comprehensive Medical and Pharmacy Claims Auditing
- Medical and Pharmacy Claims Data Warehousing
- Health Plan Modeling and Trend Prediction
- Pharmacy and Medical RFP submission and analysis
- Dependent Eligibility Auditing
You Can’t Manage What You Can’t Measure
At Seneca Consulting Group, we believe that “you can’t manage what you can’t measure.” This belief is echoed throughout our approach to benefits consulting. We have pioneered a new process in benefits consulting that we call Audit-Based Consulting. Audit-Based Consulting leverages uses technology to ensure vendor compliance with service agreements and financial guarantees. Seneca Consulting Group’s Audit-Based Consulting services include the following types of data management and analysis:
- Comprehensive Medical and Pharmacy Claims Auditing
- Medical and Pharmacy Claims Data Warehousing
- Health Plan Modeling and Trend Prediction
- Pharmacy and Medical RFP submission and analysis
- PPACA Compliance Auditing
- Dependent Eligibility Auditing
Seneca Consulting Group
Since our inception in 1997, the Seneca Consulting Group has pioneered health plan compliance protocols. Over the years we have refined our methods with the goal of improving transparency for health plan sponsors. Our clients include employers, third party administrators, insurance carriers and health and welfare funds. While our client base may be diverse, our clients share common goals:
- Understand the cost drivers of their benefit plan
- Validate the financial performance of their TPA & PBM vendor
- Identify and maximize savings opportunities
- Improve outcomes and the overall health of their members
In 2006, Seneca Consulting Group recognized the need to add a medical claims auditing component to our service offering. We embarked on the addition of a complete medical claims audit process using the same philosophy that had been successful for us with pharmacy benefit claims.
In 2010 with the passing of the Patient Protection and Affordable Care Act (PPACA), Seneca Consulting Group recognized the need to add employee hour tracking and compliance services for large Applicable Large Employers.