Direct Your Plan 

A suite of reports designed to keep companies current with respect to cost and claim controls is provided by Group Benefits Unlimited.  We offer claims information and timely reporting for benefit administrators.

Managed Drug programs ensure effective health solution delivery while controlling unnecessary exposure to new high priced drug alternatives.

Special Authorization requires Employees, their doctors and trained clinicians to evaluate a line of therapy to ensure the best drugs for the situation are utilized.  Drugs on the managed formulary and generic versions are automatically approved. Those not part of the formulary require special authorization.  Authorization requires that certain criteria be met.  This may mean a less expensive alternative, a less invasive and more effective alternative, or a more expensive but more effective alternative.
The special claims management tools are suggested when reports indicate an increasing trend toward new higher priced drugs with no generic alternative.

Audit 

Claims: each claim that enters the system is required to pass through over 100 checks and edits prior to coverage being approved or rejected. Random audits both electronic and manual are preformed by our claims adjudicator to further protect the members and plan sponsors.

Verification of compound claims, "No Substitution" claims, reimbursement claims, pharmacy statistical analysis, on-site pharmacy audits and member validation of receipt of medications are all part of an ongoing program of random and routine checks and balances to ensure the highest standard of performance is maintained for your plan.

Trending

Group Benefits Unlimited provides your team with a year over year audit of benefit utilization and cost. This audit provides you with the tools to accurately assess claim costs per benefit line over a period of time. Trending utilization is a vital tool in cost containment. Timely analysis allows for implementation of solutions before benefits are negatively impacted.