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Reducing healthcare costs for self-funded employers

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News & Blog

No Surprises Act mostly a positive change for self-funded employer health plans

The No Surprises Act took effect this year and employers could see some positive impacts to their self-funded health plans in the form of reduced out-of-network costs and simplified regulatory requirements. The new law was approved by Congress in 2020 and went into effect Jan. 1, 2022.1 The basis of
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Will ERISA reforms lead to health reforms?

Employers with self-funded employee health plans have long felt protected from state laws that attempted to regulate ERISA plans, however a U.S. Supreme Court case decided last year may begin to change that, according to benefits attorney Felicia Finston.  The 2021 Supreme Court decision in Rutledge v. Pharmaceutical Care Management
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Do all physicians have a medical degree?

Employers aiming to reduce health care plan costs could go back to the dictionary when it comes to their summary plan descriptions. From reviews of self-funded employer health care claims, analysts have found broad, sweeping definitions of “physicians” which resulted in services billed at the higher physician rate even though
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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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Recent Posts

  • SmartLight Analytics Ranks No. 148 on the 2022 Inc. 5000 Annual List  
  • High volume of small errors can add up to millions in waste for your health plan
  • The impact of transparency requirements on the healthcare system
  • City of Fort Worth prevents $1.7 million in fraudulent pharmacy payments
  • Data Solution to Tackle Fraud, Waste, and Abuse

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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