Benefits Configuration Case Study Humanizing Data for Purposeful Change AArete.com | 312.585.0800 DRIVEN BY DATA. DELIVERING RESULTS. SITUATION A local Managed Care Organization (MCO) was inappropriately reimbursing providers for unauthorized and non-covered services. The MCO approached AArete to conduct a comprehensive system configuration review of benefits and prior authorization. APPROACH AArete documented the state and MCO’s policies and compared it to the prior authorization setup and benefits configuration setup. For all discrepancies between policy and configuration, AArete quantified the applicable recoupment, prospective savings, and any key provider insights associated with the configuration fix. All recommended adjustments to configuration were documented and discussed

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