We serve as your expert liaison, ensuring accurate and timely claims adjudication, and managing the relationships with your PBM and other vendors to enforce service-level agreements.
We meticulously reconcile all funding. We prepare and submit specific and aggregate claims and track reimbursements, ensuring flawless cash flow and financial reporting.
Our team provides white-glove support for employees, especially for high-cost or complex medical cases. We navigate the system on their behalf, ensuring proper claims payment, negotiating bills, and connecting them with clinical management resources, which directly controls your plan’s largest costs.
We manage the intricate compliance requirements unique to self-funded plans, including Form 5500 preparation and filing, Summary Plan Description (SPD) updates, ACA reporting (1094/1095-C), and HIPAA privacy oversight.
We audit and validate eligibility data feeds between your HRIS and vendors. We provide you with customized, actionable reports on plan utilization, financial performance, and key cost drivers, not just standard carrier summaries.
