News & Events

Claims Transparency — Crystal Clear Insight for Self-Funded Health Care

September 25, 2017 | Tina Pelland

For self-funded health care providers, Claims Transparency is a must.

Just so we’re clear, let’s define what a claim is; a claim is a request for payment, submitted by a medical facility (hospital, doctor’s office, health clinic, pharmacy) for the costs of healthcare services or supplies administered to a plan participant. Self-funding health care providers pay for every plan participant’s claim, as long as the provided health care plan includes that medical service.

The idea of “Claims Transparency” is to be transparent about health care claims with data and insight.

Claims Transparency is much more than receiving a glorified receipt. It’s the provision of clear, understandable information such as pricing, billing accuracy, safety, quality of care — complete insight on every aspect of providing health care.

To ensure plan providers have Claim Transparency, TPAs like Varipro will provide plan reports.

These reports compile plan participant’s claim activity, health history, costs, and anything else needed for Claims Transparency. Account managers at Varipro provide these reports monthly, giving employers up-to-date information, allowing them to make well-informed decisions like:

– What coverages to include in an employee benefits package?
– How much to budget for health care costs?
– What medical facilities are the best for my employees?

Of course, employers may not have enough spare time each month to attentively review plan reports, which is why TPAs are constantly looking for overages and irregularities as they are collecting data. If found, employers are the first to know allowing them to avoid overages and unnecessary coverages. By doing so, employers ensure an excellent quality of service and hold their local healthcare community to high standards. Companies can also use Claims Transparency to customize healthcare plans further, eliminating unnecessary coverages and providing the most efficient health care plan possible.

 Learn more about Claims Transparency here: What is Claims Transparency?