How To Protect and Streamline Your Self-Insured Healthcare Plan

By DON HUTSON

Intoday’s rapidly changing healthcare landscape, HR professionals play a crucial role in ensuring the efficiency and integrity of their self-insured plans. As the prevalence of misappropriated funds in healthcare continues to pose a significant challenge, it is imperative for key HR personnel to closely monitor and review their benefit plans. This is a critical area where the status quo is no longer an option. In the context of your HR process, this article explores the evolving healthcare space for self-funded plans, the impact of the Consolidated Appropriations Act of 2021, the importance of reviewing administrative agreements, and how partnering with a competent healthcare technology company can lead to a decrease in your plan’s healthcare spend.

Self-funded benefit plans have gained significant popularity among organizations seeking more control and flexibility over their healthcare expenditures. However, this approach also brings inherent risks, including inaccuracies in claims adjudication resulting in potentially significant losses that have become bigger, not smaller, in recent years. HR managers and fiduciaries must navigate this complex landscape, constantly seeking innovative solutions to protect their organization from losses while ensuring the well-being of their employees and all plan participants. Fortunately, recent advances in artificial intelligence coupled with the latest in advanced technologies offer much deeper plan assessment and analysis than ever before.

Misappropriation of funds remains a prevalent issue in self-funded benefit plans, often resulting from coding and billing errors, fraudulent claims, or lack of robust oversight. Such occurrences not only lead to financial losses but can also erode employee trust and negatively impact an organization’s bottom line. HR professionals and plan fiduciaries should take proactive measures to mitigate these risks and safeguard the integrity of their benefit plans.

To combat misappropriation and optimize the performance of self-funded benefit plans, HR professionals must adopt a vigilant approach to monitoring and managing these programs. By leveraging the advanced healthcare technology solutions now available, fiduciaries now have access to powerful tools that identify and address fraudulent claims, detect errors and trends more readily, and offer real-time insights into not only recouping plan funds, but monitoring operations going forward.

The Impact of the Consolidated Appropriations Act of 2021... (effective January 1, 2023) has introduced critical changes that significantly impact self-funded healthcare plans. One of the provisions under this legislation requires plan sponsors to regularly review and update their administrative agreements with third party administrators. Now is the time for HR professionals to seize the opportunity to reassess their agreements and ensure alignment with the new laws. Significant new regulations, including transparency mandates and payers’ immediate response to requests for claims data will assist you in creating compliant administrative agreements. You will have stronger controls and the capability to identify any gaps or areas for improvement, ultimately strengthening your organizations’ ability to detect and prevent illegalities and problematical issues.

What BCI Can Do For You

Partnering with our healthcare technology company offers employers a powerful solution to decrease healthcare plan spend while maximizing efficiency. Our software with advanced claims analytics, AI-driven algorithms, and unique fraud detection capabilities can enable your organization to proactively identify fraud, waste and abuse, recoup losses, and gain peace of mind about the viability of your plan. By leveraging our expertise, you can unlock substantial savings and allocate resources more effectively, leading to a healthier bottom line and improved employee satisfaction. We will provide you with our Tier One “Summary Statement” on your plan at No Charge, offering indicators of the severity of issues within your plan, or lack thereof.

In the evolving landscape of self-funded healthcare plans, getting this Summary Statement is an excellent way to stay ahead of the curve and ensure the efficient and secure management of your plan. To assist you in monitoring, reviewing, and updating your administrative agreements, request our (Free) White Paper to assist you with safe and helpful guidelines. We want to provide you with an opportunity to deal with today’s challenges successfully. To arrange for your No Charge “Summary Statement” and/or a copy of our “Administrative Agreement White Paper” please email: Admin@BenefitsClaimsIntelligence.com

Don Hutson Executive VP, Chief Operating Officer Benefits Claim Intelligence, LLC don@benefitsclaimsintelligence.com

BCI is an AI-based, healthcare-related software company with the capability to identify, with refined accuracy, misappropriated funds, fraud, waste and abuse in self-insured healthcare plans. Through our experienced team of technology professionals, coupled with the machine learning algorithms we have deployed, our uniquely accurate approach to claims data research offers you valuable guidelines for ERISA Compliance, Plan Efficacy, and strategies for ongoing optimization. While the Consolidated Appropriations Act of 2021 was just put into effect January 1, of 2023, it has changed the game with regard to mandating transparency and immediate release of claims data requested by Plan Fiduciaries. We are keenly aware of its provisions and prepared to assist you in navigating this 2,200-page Act for best results.

Ensuring Claims Payment Integrity For Your Self-Insured Health Plan

• AI-based software for identifying claims payment and processing errors

• Recoupment expertise to recover funds from improperly adjudicated claims

• Capabilities for ongoing monitoring of claims payments to uphold plan efficacy

• Timely guidance to assure ERISA compliance

TWO GREAT FREE ITEMS FOR YOU AVAILABLE NOW!

1. BCI’s “Summary Statement” which we will create from your recent plan claims data to advise you of discrepancies/irregularities in claims payments and/or confirmation of proper adjudication.

2. BCI’s new 3-Part White Paper consisting of our “Consolidated Appropriations Act of 2021 Synopsis”, “Guidelines for Administrative Agreements”, and “Legal Q&A” prepared by BCI’s legal department.

To request these free items today, please email us ...

Benefits Claims Intelligence

Admin@BenefitsClaimsIntelligence.com www.BenefitsClaimsIntelligence.com