Audit-Based Consulting

Audit-Based Consulting components include Third Party Administrators
performance guarantees, and support for plan compliance with regulatory agencies.
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Audit-Based Consulting

Audit-Based Consulting components include Third Party Administrators performance guarantees, and support for plan compliance with regulatory agencies.

Services With Principle

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 technology to ensure compliance. Compliance components include Third Part Administrators performance guarantees, and support for plan compliance with regulatory agencies. Audit-Based Consulting involves three levels of data management and trend prediction. The three levels of Audit-Based Consulting include:

Medical and Pharmacy Claims Auditing

As the foundation of Audit-Based Consulting, comprehensive claims auditing is the most important step. Much like the strong foundation of a house, a comprehensive claims audit is the foundation to build a dynamic and responsive trend-monitoring program.

Our unique auditing services offer a «Best in Breed» approach, and features 100% of all claims audited. Through our auditing partners, RxAnalyer and Healthcare Horizons, our auditing services are the best in the nation.

Claims and Data Warehousing

Since our audit services provide 100% of all medical and pharmacy claims audited, we have the unique ability to data-warehouse claims information for our clients. Both the medical and pharmacy auditing programs utilize SQL technology; we can offer an application compatible to data integration.

This step also benefits the plan during transitions of third-party administrators and pharmacy benefit managers.

Objectivity and Independence

We maintain objectivity and are free of conflicts of interest in discharging our responsibilities. We are independent in fact and appearance, and provide objective advice and guidance to clients.

Plan Modeling and Risk Prediction

The final stage of Audit-Based Consulting combines the benefits of all stages. Since we offer auditing claims data, in an easy-to-access data warehouse, actuaries, consultants and underwriters have clean and accurate data to forecast future costs and health care trends. SQL technology also offers the ability to export to any data integration and risk prediction application that meets the needs of our clients. Seneca Consulting Group’s staff brings years of experience in working with many of the nation’s leading insurance companies, Third Party Administrators (TPA), pharmacy benefit managers, dental providers, and employer groups. This experience is passed on to our clients to facilitate the decision-making process and provide solutions to complex issues.

Objectivity and Independence

We maintain objectivity and are free of conflicts of interest in discharging our responsibilities. We are independent in fact and appearance, and provide objective advice and guidance to clients.

Due Care

We observe the profession’s technical and ethical standards, strive continually to improve competence and the quality of services, and discharge professional responsibility to the best of our ability.

Scope and Nature of Services

We observe the basic principles of professional conduct in determining the scope and nature of services to be provided.