Standard Services Provided to Your Client on Your Behalf:
Annual Plan Review and Renewal – Prior to the anniversary, a strategy meeting will be requested to discuss the goals of the self-insured plan for the upcoming year from a benefits and budgetary perspective. Based on the goals of the plan, a detailed analysis will be completed and presented to you and your client. Ideas for reducing costs and overall management of the plan will be provided.
Stop Loss Coordination and Tracking – Each month, you and the client will be provided with reports identifying all potential and actual stop loss participants. If an individual should exceed the specific stop loss deductible, all dollars will be tracked.
Claims Administration Oversight – On an as needed basis, in instances of elevated or complex claim issues, there will be coordination between your client and our team; as well as providers, employees and the plan administrator. Regardless if the issue is regarding a claim or a claim process, we will be involved so that issues are resolved quickly and expertly.
Large Case Management – We will oversee the management of individuals with ongoing chronic conditions or large claims. Reports will be provided identifying the types of events and illnesses. In addition by tracking patients in large case management we can focus the claim administrator on Disease Management efforts with the claims administrator.
IBNR Calculation – The frequency of IBNR adjustment will be determined by the client. It will be calculated and reported by our office based on the frequency requested.
Document Preparation and Review – Documents including those between the client and the carrier/vendor as well as Plan Documents/SPDs will be reviewed.
Loss Analysis and Data Mining – It is critical to track utilization and drill down the information in order to clearly understand the covered population. This process allows us to manage the claims incurred by the plan. As an example in the loss analysis and data mining process if we see claims for drugs increasing, our data mining will identify why that is happening. Another example is with complex radiology claims. We might identify increased utilization or overall utilization that is higher than what is expected for the demographics of the client. Through our process of loss analysis and data mining, we are able to identify any issues that may exist. We then report the finding to the client along with any recommendations for making changes. This process reviews all medical and drug claims.
Monthly, Semi-Annual, and Annual Claims Analysis/Reporting – Reports custom for the client will be provided identifying the medical/Rx expenses and plan utilization.
Disease Management/Wellness Development –Claims utilization is monitored very closely on an ongoing and regular basis. It provides us the ability to identify opportunities for helping individuals manage chronic conditions while also providing guidance on which wellness efforts will make sense for the employees and dependents of your client.