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Reducing healthcare costs for self-funded employers

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Inappropriate ER use has gone from serious to critical

Everyone will agree that emergency care is a necessary and important part of the US healthcare system. Timely access to emergency care is undisputed. The role of the ER is undermined, however, when used for non-emergent care that can be safely rendered elsewhere. A recent report by Accenture examined one
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Who’s Watching the Money?

The expanding cost and responsibilities associated with employer-sponsored healthcare Businesses across the board, from automakers to tech companies to taxpayer-funded school systems, spend a large portion of their budgets on employees in the form of salary and benefits. A rapidly growing percentage of these costs go to fund employee healthcare
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SmartLight Analytics opens new Plano, TX headquarters

PLANO, TX – SmartLight Analytics opens its new Plano, Texas, headquarters this week beginning a new chapter for the growing team of data and clinical experts working to help self-funded employers to reduce healthcare spending by identifying and eliminating fraud, waste, and abuse in healthcare claims.   The new office
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Eliminating Out-of-Network Benefits Saves Employers Money and Discourages Fraudulent Claims

Eliminating out-of-network (OON) benefits in self-funded employee healthcare plans tackles several  problems for employers and benefits administrators: healthcare plan costs, dealing with laborious ERISA out-of-network appeals and the potential for fraud. Employers and their insurance companies negotiate contracts with in-network healthcare providers and facilities such as hospitals and rehabilitation centers.
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Telemedicine leaves space open for FWA

The continued use of telemedicine – made dramatically more mainstream during the pandemic – may open the door for more fraud, waste, and abuse in healthcare claims. The number of fraud cases related to healthcare “more than doubled from 2019 to 2020 and was at the highest level ever reported”
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Recent Posts

  • City of Fort Worth prevents $1.7 million in fraudulent pharmacy payments
  • Data Solution to Tackle Fraud, Waste, and Abuse
  • No Surprises Act Mostly a Positive Change for Self-Funded Employer Health Plans
  • Will ERISA Reforms Lead to Health Reforms?
  • Do All Physicians Have a Medical Degree?

See all SmartLight Blog posts.

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SmartLight White Papers

The expanding cost and responsibilities associated with employer-sponsored healthcare

As the rising costs of healthcare benefits and the rising percentage of employee contributions converge, companies across America are faced with a new scenario that finds them looking for ways to reduce healthcare spending and protect their employees’ contributions. How should a business whose mission is to build cars or develop software deal with this increasingly complicated situation?

Download SmartLight’s Whitepaper:

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SmartLight Analytics combines the best inferential analytic models with a team of analytic  and clinical experts to find fraud, waste, and abuse in self-funded employer health care plan claims data.
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