Plan Management
Covering Plans from A to Z and Innovating Claims Administration
We provide consultative plan management services on a variety of benefit structures, providing experience and expertise in:
- Self-funded and fully-insured medical, dental, and vision plans
- Cafeteria plans
- Consumer-directed plans
- Eligibility structures
- Financial and Experience Reporting
- Cost containment strategies
Being able to track your claims and provide detailed utilization reports on plans, including diagnoses groups (DRG’s), PPO network discounts, and provider utilization, means meaningful planning and management for you.
We can also help you identify attempted fraudulent claims activity. This provides our clients with the operational awareness of their plan assets to create useful tools in planning for future modifications.
In addition to management and reporting, we support a range of other plan services including:
- PCORI & Reinsurance Fee Calculations and Payment
- 6055 & 6056 ACA Reporting (1095-C, 1094-C, 1095-B)
- Dependent Eligibility Audits
- Plan Discrimination Testing
- 5500 Reporting and Filing
- Plan Document Review
- PPO Network Utilization and Analysis
- Pharmacy Utilization and Savings Analysis
- Direct Provider Contracting
- Specialty Medication Price Mitigation
