In a world of no, AVYM means yes.
AVYM works to Identify, Recover and Protect both public and private Self-Funded Employer Group Health Plan Assets that have been retained by TPAs but have not been restored or refunded to the originating Employer Group Health Plans, as required under federal statutes and Fiduciary Responsibilities.
Our Proprietary Data Validation System, checks for discrepancies or omissions of data, incorrect codes or coding combinations, and compliance with existing federal and/or state regulations.
Our Process assists clients achieve transparency and control by providing the following benefits:
- Demystify overpayment recoupments occurring between TPAs and providers, and/or facilities;
- Identify and correct improper processing practices which result in lost plan assets due to excessive hidden fees disguised as claim payments;
- Pinpoint vague or problematic ASA/ASO Agreement terms or provisions and their practical implications;
- Provide a turnkey outsourced operation, with little to no upfront costs to Plan Sponsors;
- Conduct ongoing monitoring of client’s medical claims, helping Plan Sponsors comply with their Fiduciary Responsibilities to monitor and safeguard plan assets;