Insights

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Cost Containment for Smaller Self-Insured Health Plans: What Matters Most and When an Audit May Be Appropriate

Cost containment is a central responsibility for any self-insured health plan sponsor. Plan fiduciaries are expected to monitor vendor performance, understand cost drivers, and ensure that plan assets are used appropriately. Independent audits and formal oversight mechanisms can play an important role in fulfilling those responsibilities, particularly for larger plans with significant claim volume and…

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ai software processing insurance claims.
Artificial Intelligence and the Rise of Duplicate Claims: What Plan Sponsors Should Understand

Artificial intelligence is transforming the healthcare claims ecosystem. Providers are using AI-driven tools to accelerate billing, automate coding, and optimize revenue-cycle management. Simultaneously, third-party administrators (TPAs) and insurance carriers are integrating AI into claims adjudication and operations to manage increasing claim volumes. For plan sponsors, the issue is less about the use of AI itself…

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DOL’s PBM Proposal: What it Signals About Fiduciary Expectations and How Plan Sponsors Can Use It

The U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) recently proposed a regulation to increase transparency in pharmacy benefit manager (PBM) compensation and financial arrangements. While initial discussions have focused on technical details, the proposal’s greater significance lies in what it signals about evolving fiduciary expectations under ERISA and how plan sponsors can use…

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Overpayment Recovery: The Often Overlooked Oversight Responsibility of Plan Sponsors

When a plan sponsor hires a third-party administrator (TPA) or insurance company to administer its self-insured health plan, it’s easy to assume overpayment recoveries are being handled. But that assumption can be costly. One area where plan sponsors routinely fall short in their oversight responsibilities is in monitoring overpayment recovery efforts, a critical component of…

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self insured health plans
Strengthening Oversight of Self-Insured Health Plans

Employers that sponsor their own self-insured health plans rely heavily on third-party administrators (TPAs) and pharmacy benefit managers (PBMs) to process claims, manage networks, control costs, and deliver programs that support a healthier workforce. Yet without deliberate and structured oversight, plan sponsors are vulnerable to heightened operational, compliance, and reputational risks that can erode financial…

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Implementing Best Practices to Strengthen Fiduciary Oversight for Self-Insured Health Plans

Health plan sponsors must adopt best practices to proactively address potential risks and uphold their fiduciary duties. Several steps can be taken to avoid pitfalls and implement oversight. Fiduciary oversight is not just a regulatory requirement; it’s a fundamental responsibility to safeguard the interests of plan participants. Recent Department of Labor (DOL) investigations demonstrate the…

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