Gain a Competitive Advantage

C2 has partnered with AIM, a national, independent claims and benefits firm that specializes in reviewing self-funded health plans to build a proprietary claims audit program unlike any other in the market.

C2 ClaimsCheck is designed to give employers and plan sponsors the most thorough and comprehensive audit of their health plan using best-in-class methodologies and auditing techniques unique to C2.

Why C2 ClaimsCheck?

• Best-in-class audit model that yields the best results for employers and plan sponsors
• Unique approach
• Sound methodology
• Strong results with the right focus
• Independent
• End-to-end engagement
• Universally accepted by carriers and TPAs
• Experience with all major carriers and TPAs
• Audit experience with noteworthy employers and plan sponsors

C2 ClaimsCheck Differentiators

Our audit approach is intensive and not based on any pre-screening by systems or software. We examine each claim line by line, dollar by dollar, using the client’s plan materials as the “source of truth” for accuracy.

C2’s ClaimsCheck applies a collaborative approach in conducting audits; we focus on identifying issues and having them corrected to avoid future issues or gaps. Once errors are identified, we remain engaged on the client’s behalf to ensure all errors are resolved, and where applicable, refunds and credits have been applied or returned.

Our process ensures that in the end we deliver a complete review of a client’s claim processing and administrative service engagement instead of just an audit of claims in a sample.

Optimize 360

For leveraged contract savings and world-class service, RxBenefits handles every aspect of the pharmacy benefits process, from initial contract negotiations to ongoing plan support to world-class client and member services. RxBenefits negotiates with the big three PBMs competing on our marketplace for the employer’s business with fully transparent, client-aligned, guaranteed discounts and rebates. With that 12-month contract comes an annual review of the plan’s performance to ensure the plan sponsor receives everything their contract promised.

Optimize Direct

For clients who need or prefer to contract directly with the PBM, Optimize Direct offers all the benefits of RxBenefits, plus independent expertise for their three-year contract. Our account managers, independent pharmacy advisors and proprietary analytics are at the service of your clients, providing analysis and recommendations beyond what the PBMs offer. Additionally, semi-annual checks and annual reconciliations within the three-year contract period ensures that guarantees are fulfilled. 

Protect

Comprehensive, independent clinical oversight for utilization management that matters.

Designed and led by RxBenefits’ team of independent PharmDs, the RxBenefits Protect™ suite of clinical solutions delivers oversight, expertise and intervention to eliminate wasteful pharmacy spending while protecting the health and safety of plan members. Our Protect™ solutions enable members to get the most cost-effective medications they need to drive the best health outcomes so that they can live healthy and productive lives – while enabling plan sponsors to provide a robust pharmacy benefit for their members without threatening their own bottom line.

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Whether you need help working through a complex employee leave scenario, require a more effective leave tracking tool, want to create a stronger Manager Leave and ADA training program or are interested in more information on any given leave or disability law, our absence experts are here to support you.

C2 Absence Navigator encompasses six easy-to-use tools to manage leave of absence programs effectively while maintaining complex federal and state regulatory compliance rules.

• Leave Genius Pro subscription
• Complimentary one-year DMEC membership
• Subject matter expert consulting
• FMLA + ADA training for managers
• LOA + ADA letters suite and workflows
• Regular compliance updates and webinar series

C2 Absence Complete offers comprehensive absence management, designed to fit unique absence and leave client needs.

Why You Should Choose Absence Complete

• Custom services and timeline of initiatives to fit client needs
• Dedicated client service team that provides ongoing SME and advisory support
• Discovery and review of client’s current program
• Leave and ADA program analysis
• RFP and implementation
• Reporting and analytics (PFML)
• Leave administration solution recommendations
• Software solution (insourced)
• Outsourced (carrier or TPA)
• Fees based on scope needed by client

Explore Our Process

• Discovery: criteria and process
• Absence management assessment scoring tool
• SWOT analysis
• Observations
• Recommendations
• Solution implementation and program management

C2 Benchmarking is powered by Bnchmrk, a software and data company that focuses solely on providing employee benefits benchmarking to brokers and consultants. In addition to medical and Rx benefits, Bnchmrk can also provide benchmarking reports for dental, vision, life, short-term disability and long-term disability to brokers. Bnchmrk’s robust database covers more than 7,500 employers nationwide and includes more than 65,000 active benefit plans from medical to disability. The benchmarking data is sourced from both an exclusive national employer survey as well as direct licensing deals with brokers and consultants across the country.

C2 Actuarial Pricing Support offers a comprehensive report describing methodology and considerations, a trusted and highly credible nationwide data source, actuarially sound development of large group rating factors and more.

Practical Functionality for Agencies

• Manual rating for groups without fully credible experience
• Benchmarking against existing funding and rating structures
• Valuable insights into risk dynamics inherent in actual claims experience

Wakely Factors Provided

• Age-gender factors
• Separate medical and pharmacy 
• Included with and without adjustments for newborns
• Enrollment tier factors
• Standard tier rates from 2-tier to 5-tier
• 4-tier factors by age grouping
• Regional factors by metropolitan statistical area
• Historical annualized trend ranges
• Summarized by four major regions and nationwide
• Utilization and unit cost trend by major service category

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C2 Solutions Catalog is an online application that catalogs the solutions available to employers in the benefits space, from carrier-specific products to technology solutions. Consultants, producers and AMs will be able review (using a 5-star scale), comment on and state if they’ve implemented a solution. This sharing of solutions among our six member firms help us to elevate a solution quickly and efficiently.

How It Works

• At any point in the year, establish a pre-certification feed to Goldfinch and we'll take care of the rest.
• See measurable results after your first C2 Surgery Experience case. 
• Pay a per-case fee only when the program is used. 

Benefits

• Get employees back to work and life in half the time.
• Prevent your net high-cost claimant.
• Stop long-term opioid dependency on your watch.

Access To Enhanced Surgical Pathways

Fast-tracks your people to recovery, minimizes opioid use and lowers the risk of infection and re-operation. 

Guidance From a Goldfinch Nurse Navigator

Safeguards confusion and ambiguity throughout the surgery and recovery process.

Focus On Patient Outcomes That Matter 

Saved days in returning your people to work and life is our primary metric of success. 

C2 Surgery Experience tracks program success using a number of measures, including saved days in recovery time/return to work. This metric is a leading indicator of high-quality surgery. To calculate, C2 Surgery Experience compares member experiences against matched patients in the MDGuidelines Database. For more details about this Validation Institute-certified methodology, visit GoldfinchHealth.com.