New solution is the only end-to-end process ensuring large claims are managed properly through entirety of engagement, both clinically and administratively
CAMDEN, NJ (July 27, 2021) – Conner Strong & Buckelew, a leading insurance brokerage and employee benefits consulting firm, is proud to announce ClaimCheck, a unique and proprietary employee benefits claims screening process in place to ensure large and catastrophic claims are being properly managed by the complex healthcare system, adjudicated pursuant to the Plan of benefits, and paid properly.
The new process is a response to the increasing number of larger claims from self-funded employers and plan sponsors, a result of technological enhancements and medicinal innovations, which have greatly improved the ability to treat conditions. In fact, according to Sun Life, from 2016-2019, nearly 25 percent of employers had at least one member with over $1 million in claims.
ClaimCheck is the only end-to-end process available to ensure large claims are being properly and efficiently managed. At any time over the course of a claim’s handling, the ClaimCheck process includes guard rails to engage clinical and administrative checks to safeguard the client and patient’s interests.
“We expect more frequent, larger claims will become the norm across the industry, so we’ve developed a proprietary process for our clients to use when navigating this new reality,” said Joseph DiBella, Executive Vice President of Conner Strong & Buckelew. “ClaimCheck will give our clients greater peace of mind, knowing that large claims are being closely and carefully scrutinized every step of the way.”
The ClaimCheck process will include the following five steps:
- A claim will be flagged for review by a Conner Strong & Buckelew clinical nurse once it reaches either $100,000 or 50 percent of the client’s stop loss deductible, whichever comes first. The claim is reviewed for eligibility, care management effectiveness and ongoing monitoring to ensure all needed care management oversight is in place.
- If needed, a clinical nurse reviews the care management plan and options with the health plan’s care management team. If warranted, the claim is elevated to the Conner Strong & Buckelew physician Chief Medical Officer for a more thorough clinical review.
- Once flagged, these claims remain under “open” management by the clinical team at Conner Strong & Buckelew to ensure appropriate care management. This ensures proper evaluation over the course of the engagement.
- Claims remain open until treatment is concluded and/or until the client receives applicable stop loss payment. Even after payments are made, claims are monitored for ongoing appropriateness.
- Finally, any claim more than $200,000 goes through a case audit of the carrier’s adjudication accuracy of the claim to ensure all claims were paid properly.
The stages of the ClaimCheck process have been methodically developed, ensuring no large claim is overlooked or mismanaged throughout the course of engagement.
Conner Strong & Buckelew’s employee benefits clients will have access to ClaimCheck immediately.
About Conner Strong & Buckelew
Conner Strong & Buckelew is among America’s largest insurance, risk management and employee benefits brokerage and consulting firms. The firm is an industry leader in providing high-risk businesses with comprehensive solutions to prevent losses, manage claims, and drive bottom line growth. Its employee benefits practice focuses on providing best-in-class benefits administration, health and wellness programs and strategic advisory services.
Founded in 1959 with offices in New York, New Jersey, Pennsylvania, Massachusetts, Delaware, Florida, and Georgia, Conner Strong & Buckelew has a team of more than 400 professionals, serving clients throughout the United States and abroad. For more information, visit www.connerstrong.com or follow us on LinkedIn (@ConnerStrong&Buckelew), Twitter (@connerstrong), Facebook (@connerstrongbuckelew) and Instagram (@connerstrongbuckelew).
