Specific Stop Loss Claims
Outsourcing Specific Stop Loss Claims to CBA provides clients an immediate and credentialed solution. CBA seamlessly interacts with frontline administrators and provides a level of assurance to risk takers behind the underwritten programs that claims are being thoroughly managed.
Aggregate Stop Loss Claims
CBA is a trusted resource for handling the complexity of these claims that involve nearly every aspect of a Health Plan’s administration. Well-regarded by leading risk takers, CBA has earned a distinct reputation for producing substantial savings that average up to 40% of the filed claim.
HMO Re & Provider Excess Claims
Managed Care Claims require specialized data management and a strong overlay of claim knowledge. CBA is heavily invested in these skill sets and provides repricing and adjudication resources to a number of entities in this growing market.
Carrier & Reinsurer Claims
CBA reviews catastrophic claims incurred under quota share and excess of loss programs with a strong emphasis on eligibility, disclosure and adherence to coverage under the risk layers that concern the respective Carrier and Reinsurer. This high-level review focuses on global aspects, from the underlying Plan Document, to the Stop Loss Policy to the Treaty terms that collectively affect the risk bearers.
Claim Overflow Management
CBA has established a turnkey integrated process that can be quickly deployed to help securely meet service standards and turnaround time goals during peak claim activity or when unexpected staff changes present significant challenges.
Regulatory and internal compliance standards frequently mandate that Stop Loss Carriers and Reinsurers routinely audit claim and premium accounts administered under their contracted underwriters. CBA claim and eligibility expertise frequently partners with our client when auditing MGU claim and premium accounts, often going on-site in tandem with client representatives.
Administrator audits should establish confidence that your claim administrator is properly qualified and meets current standards with respect to payment accuracy and cost controls. CBA provides assessment services covering all aspects of claim administration functions.