Plan Document Review
Claim adjudication is only as good as the underlying Plan Document dictating the terms of coverage. The consequences of a poorly drafted Plan Document are dramatic and often expensive. CBA collaborates with legal opinions to review Plan design and content that protects against unexpected vulnerabilities and keeps Plan Sponsors compliant.
Stop Loss Policy Review
Gaps in coverage and use of non-standard industry language between Plan Documents and Stop Loss Policies can result in conflicts that lead to claim disputes and damaged relationships. CBA provides Policy reviews for Plan Sponsors and Insurers that are rooted in our substantial experience adjudicating claims in this complicated environment.
General Claim Consulting
The ever-evolving and complex nature of health insurance and coverage options can be difficult to navigate. CBA has seen many successes and challenges incurred by Plan Sponsors, Administrators, Underwriters, Carriers and Reinsurers come to light, and we prefer to be involved with that experience before clients find themselves in the throes of a claim dispute. We work to map preferred claim procedures, processes and protocols that limit complications, increase efficiencies and ultimately grant visibility to underlying issues affecting loss ratios of the parties involved.
Complex Claim Reviews
Catastrophic medical claim liability has inherent layers of information contributing dramatically to the overall eligible expense. CBA is uniquely qualified to assess those factors and quantify that underlying liability before applying losses across the appropriate risk partners.
Claim Quality Review
When CBA helps a client identify and resolve issues, they remain resolved to prevent recurrence and to stay ahead of any new challenges. A reliable strategy for this ‘sentry effect’ is to engage CBA as an outsourced Quality Review agent that samples claims on a scheduled basis and provides regular input to the client and administrator alike. These alliances are designed to improve overall performance and strengthen core skill sets.
Adjudication of medical claims has become highly automated and reliant upon technology, marginalizing emphasis on the training of the claim examiner. CBA’s experienced team works to ensure claim departments are current on the nuances of Stop Loss Claims processing, with training sessions custom-designed to meet your needs and delivered on-site or via web conferencing.