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ClaimCheck

Rest easy knowing your largest claims are managed properly.

Sophisticated technology, new medications, and novel medical procedures have elevated healthcare providers’ ability to diagnose and treat severe illnesses to new levels. These medical advancements are incredible for patients. But they are also increasing the frequency and severity of large and catastrophic employee benefits claims that can cause financial stress for self-funded employers.

As medicine continues to advance, large claims will become the norm. Employers need to ensure these claims are managed properly and that they’re not overpaying for certain procedures, treatments, and medications.

Large and Catastrophic Claims Screening for Self-Funded Companies

Conner Strong & Buckelew’s proprietary ClaimCheck solution provides our self-funded customers peace of mind. This unique employee benefits claims screening process ensures large and catastrophic claims are being properly managed by the complex healthcare system, adjudicated pursuant to the plan of benefits, and paid properly.

The ClaimCheck Process

  1. 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 and ongoing monitoring to ensure all needed care management oversight is in place.
  2. If immediately needed, the 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.
  3. 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.
  4. Claims remain open until treatment is concluded and/or the client receives applicable stop loss payment. Even after payments are made, claims are monitored for ongoing appropriateness.
  5. 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.

Contact us for more information on how to ensure your claims are being managed properly.

Practice Leader

Joseph M. DiBella

Managing Director, Executive Vice President, National Health & Benefits Practice Leader

More than 27 years of employee benefits experience

Previously led national and large account business for Horizon Blue Cross Blue Shield of New Jersey