Healthcare Horizons professionals have worked for, or with, many of the major healthcare insurers in the country. Our experience with payers allows us to conduct self-insured employer reviews much more efficiently and effectively than our competitors. Because we review the entire dataset of claims rather than a sample, Healthcare Horizons is able to target specific areas of concern to review with the payer. This also allows us to identify the root causes of claims errors so that our clients can minimize future claim overpayments.   In addition to our operations and technology expertise, we have a staff of comprehensive healthcare skill sets upon which to draw should the project require it. We have professionals with experience and credentials in clinical coding, nursing and healthcare finance. The breadth of our professional expertise allows us to identify more complex issues in claims payment as well as devise operational solutions to prevent future occurrences.   During this process, Healthcare Horizons remains sensitive to the relationship between an employer and their Third Party Administrator and works to minimize the amount of resources required by the Third Party Administrator. In addition, Healthcare Horizons is often able to work with the Third Party Administrator to make operational improvements to benefit both the Third Party Administrator and our client.   In addition to providing claims audit services, Healthcare Horizons also provides other services to assist large self-funded employers manage their healthcare costs. Examples of these services are:   • Health benefits analysis • Pharmacy program review • Eligibility reconciliation and process improvement • RFP and contracting services • Fee schedule analysis • Utilization and network analysis • Reinsurance analysis • Cost containment strategies

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