QBA Consulting Corporation specializes in Quantitative Benefits Administration audits, data analysis, and consulting on cost controls and program stewardship in health benefits administration. QBA has the experience of auditing most of major insurance carriers and third‑party administrators (“TPA”) in the country.  


Richard M. Stohl and William G. Burke, III co-founded QBA in 1991, out of a belief that the traditional statistical approach used in auditing health claims was antiquated.  Based on Richard’s governmental experience in auditing the Federal Employees Health Benefits Program (“FEHBP”), he realized that the traditional statistical method of claims sampling did not provide adequate assessment of the total administration of benefits plans. Richard and Bill combined innovative computer technology with an exception-based auditing methodology to develop a more practical approach to evaluating claims administrators’ performance. QBA’s Medical Analysis and Review System (“MARS”) was designed specifically to test claims adjudication and processing controls over high-risk areas in claims administration.


While most other audit and consulting firms use the traditional statistical sampling approach to claim audits, QBA takes a more innovative and pragmatic approach. The survey audit and the electronic analysis of 100% of the claim universe are the two steps that help focus on the broader issue of controls over claim administration and other financial exposures to the benefit plan. Rather than just providing statistical assurance that claims are paid within an acceptable error rate, QBA identifies those claims that have been overpaid, determines what caused the overpayments, and recommends the establishment of controls and reporting system to minimize future errors. The identification of actual overpaid claims makes it possible for the claims administrator to recover and refund overpayments to the Plan through its normal claim overpayment recovery process. The bottom-line result of the MARS analysis represents the identification of actual overpayments in the claim universe rather than an inferred projection of the estimated error.


Additionally, QBA’s audit effort is focused towards identifying inefficiencies and weaknesses in claim administration that provides opportunities for cost savings. Because of our specialization and extensive experience, we are also able to provide suggestions for improving the administration and stewardship of the Plan.  Rather than use a theoretical approach on how the administrator should be performing; we evaluate, through the audit process, how well they are performing. We identify mistakes in past performance, analyze the cause of them, and provide recommendations for improving and controlling future performance. QBA’s audits have resulted in millions of dollars in cost recoveries and more in future cost savings. A QBA audit also provides management with a stronger and more thorough basis for contract negotiations. 


Specifically, QBA distinguishes itself from its competitors by:


·         Audit Experience – QBA Consulting Corporation has performed over 200 health benefits administration audits for corporate, government and non-profit organizations. This experience provides QBA with the industry knowledge and other programs to make benchmark comparisons of your plans and its administration to that of similar organizations.


·         Consulting Advice – Our audits are not leveraged to less-experienced staff personnel.  QBA consultants have an average of 20 to30 years experience in auditing and consulting on health benefit administration and prescription drug programs. QBA consultants provide effective, practical recommendations for improving Plan administration, contracting, and claim processing controls.


·         Success of Proprietary Software - Due to the track record of the MARS system, it has been our experience that the high rate of accuracy produced by the system tends to reduce wasted audit effort and allow the audit staff to quickly focus on the areas of greatest exposure. This focus has allowed most of QBA’s clients to recover and discover savings, which exceeds the project cost. QBA's electronic analysis of 100% of the claim universe will identify those overpaid claims that have not been corrected and will provide positive assurance that the majority of claims had not been overpaid.




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