Claim Administration & Compliance

Aggressive claims reviewing is a key element of cost containment and translates into managing fixed cost and stop loss premium increases. Insight’s claim processing system logic, partnered with additional independent review points, provides multiple levels of claim editing. This comprehensive approach to claim payment ensures that every procedure is appropriate and every dollar spent is justified. Our vendor partners integrate with the claim logic to maximize savings and minimize claim payment errors.

Insight’s daily claims operations include:

• Reviewing for appropriateness of billing
• Investigating for potential third-party liability
• Benchmarking best practices and fees for similar diagnoses and procedures
• Monitoring trends in dashboard reporting
• Delivering comprehensive and robust claim reporting
• Ensuring legislative compliance (e.g. ACA, HIPAA, COBRA, IRC 125)

Deploying multiple review edits and the best-in-industry standards results in trend well below industry average. Ensuring compliance avoids penalties and other service issues for you.