How It Works
At US Beacon, we deliver pre and post payment medical claims review that ensures accuracy, compliance, and cost containment for self-funded health plans.
Sign BAA
Signing a BAA initiates a secure, HIPAA-compliant partnership that allows US Beacon to begin reviewing claims on your plan’s behalf.
Claim Submission
Medical claims are routed to US Beacon before payment, typically through the plan’s TPA or directly from the administrator.
Line-by-Line Expert Review
Our licensed physicians, nurses, and certified coders perform a comprehensive audit of each claim. We review:
Coding Accuracy
• Medical Necessity
• NCCI Unbundling & Modifier Misuse
• Implanted Device Validation
• DRG Accuracy (inpatient claims)
• Usual & Customary vs. Billed Charges
• Price Transparency Compliance
• Fraud, Waste, and Abuse Indicators
Proprietary Technology & Benchmarking
We apply our proprietary rules engine, pricing databases, and regulatory standards (CMS, AMA, NUBC, ERISA) to flag ineligible charges and overbilling.
Repricing & Recommendations
We issue a recommended payment amount (RPA) for each claim, identifying ineligible or inflated line items and calculating the fair, compliant payment.
Plan Approval
The reviewed claim is returned to the plan administrator or TPA with our findings. Final payment is made.
Provider Support & Appeals
If a provider challenges the review, our clinical and compliance teams defend the findings with documentation, reducing appeal risk. Our appeal rate is less than 1%.
Reporting & Transparency
Clients receive detailed savings reports, audit trails, and insights that help ensure fiduciary compliance, validate plan oversight, and drive sustained long-term cost control.
Redefining Healthcare Costs, On Your Terms
Control Costs by Catching Errors Before They’re Paid
At US Beacon, we’re transforming how healthcare expenses are managed, putting control back in your hands. Our powerful suite of services ensures you only pay what you truly owe, nothing more.
And because we believe in earning your trust, our success-based fee model means you don’t pay us unless we deliver savings. No risk. No guesswork. Just results.
Want proof? We’ll process 4 claims at no cost to you. Let us show you what smarter healthcare spending looks like.
92% of Claims Reviewed Result in >21% Savings
Average Savings on 56,000 Total Claims Reviewed in the Past 5 Years
Over 41% Savings
31% - 40% Savings
21% - 30% Savings
11% - 20% Savings
Under 10% Savings
Success Stories
“US Beacon has been an invaluable partner in ensuring our clients’ claims are reviewed with precision and integrity. Their ability to identify billing discrepancies, reduce costs, and navigate complex compliance issues sets them apart in the industry. Their expertise adds significant value to our brokerage services, giving our clients the confidence that their healthcare dollars are being spent wisely.”
— Benefits Advisor National Brokerage Firm
“We’ve worked with several claims review companies over the years, but none compare to US Beacon. Their attention to detail, compliance knowledge, and ability to maximize savings set them apart from the competition.”
— SVP at a Leading National Food Distribution Company
“We thought our claims were being processed correctly until US Beacon’s audit revealed excessive charges and billing errors. Their proprietary review process caught discrepancies that had gone unnoticed for years. We trust them completely.”
— COO, Manufacturing Company
Insights That Save: The US Beacon Blog
Explore the US Beacon Blog for expert insights on healthcare expense management, claims optimization, and cost-saving strategies. Stay informed with the latest trends, success stories, and practical tips to take control of your healthcare costs with confidence.
