As the ever-evolving Employee Retirement Income Security Act (ERISA) reached its 50th anniversary this year, employers need better ways to monitor healthcare claims spending to ensure they are acting in their members’ best interest.
Employers operating self-funded healthcare plans shoulder the ultimate fiduciary responsibility when it comes to spending health plan dollars for employee medical care. The Department of
Ongoing monitoring analyzes 100% of healthcare claims data continually to look for issues to help employers make plan decisions.
An old scheme previously identified in Long Term Care (LTC) facilities has become routine in residential mental health settings as well. An increasing number of suspect mental health facilities are viewing its residents as revenue streams at the expense of the employers’ health plans and driving up costs.
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The process of paying a medical claim involves multiple stages with built-in checks and balances. Yet because the process used by claims administrators is largely automated and complex, errors in claim payments persist, costing self-funded employers millions.
