1.
Review before payment
We coordinate with a self-funded plan’s TPAs, brokers, and stop-loss carriers to review high-dollar medical claims before full payment is made. Not a recovery model working backward after the money is gone.
The independent reviewer for large healthcare claims
At Highlight Health, we believe it’s time for the people writing the checks to know the price is right before they pay.
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What our review finds
We find the gap between what’s approved and what’s owed.
$2M
Savings identified on one claim
$3.5M network-approved → $1.5M owed [1]
Exact: 515 claims over two years, each exceeding $100K, roughly 9 in 10 in-network. $86.8M billed, $51.2M network-allowed, $20.8M after review. All 515 claims were repriced, paid, and settled. Each claim is unique and past results are not a guarantee as to future claims.
Three things,
done deliberately.One Documented Record.
done deliberately.One Documented Record.
Every review we complete produces one thing: a Documented Record of what the price should be, and why.
2.
Always independent
Highlight Health takes no revenue from the providers, networks, PBMs, or carriers it reviews, and discloses every relationship so independence can be verified, not just asserted.
3.
Every angle applied at scale.
Contracts, network terms, published rates, and regulatory requirements, weighed together on every review, at the volume a self-funded plan requires. Not a single data point treated as the whole answer.
Why the record holds
Every claim moves from opaque to verified through four disciplines that turn a decision into evidence the plan sponsor can stand behind.
True. Did it happen, and should it have?
Each claim is tested against reality before it’s tested against price: the services were rendered as billed, medically necessary, and are what they claim to be.
Accurate. Is every line and every dollar right?
Coding, line items, and pricing are verified against the standards that govern them: the network contract, the plan documents, the published rates, the applicable law, and the hospital’s own published financial assistance policy, a pricing anchor almost no one else applies.
Complete. Does the plan have everything it needs?
A payment determination is only as good as the record behind it. Highlight Health obtains what the plan is entitled to: the itemized bill, the medical records, the governing contract terms, so the decision is made on the full file, not a summary line.
Defensible. Will it hold when questioned?
Every finding carries written citations to the specific law, contract clause, plan term, or published rate behind it. The Documented Record can put it in front of a provider, network, or the Department of Labor to prove it.
Our process
Complete review. Inside the plan’s deadline.
A self-funded plan is entitled to the information it needs before deciding whether to fund a claim. Highlight Health’s review begins once that documentation is in hand, and it’s built to finish in 10 days, well inside the plan’s typical 30-day window.
Day 1Day 10
Claim flagged.
Review opens once documentation is complete.
Checked against everything that governs it.
Record delivered. Regardless of outcome.
Built to withstand inquiries and appeals.
Who we serve
Plan Sponsors
A handful of claims decide your plan year. Start there.
Large claims are where a self-funded plan wins or loses the year, and they’re the spend that gets the least scrutiny before it’s paid. We work through the TPA, broker, and stop-loss relationships you already have. Nothing about how your plan runs has to change.
For plan sponsorsBrokers
Walk in with something the incumbent stack can’t match.
Your clients feel the large-claim problem. Almost none of them have seen a real answer to it. Advisors use Highlight Health to put independent pre-payment review on the table, in their own name, with their client relationships intact.
For brokersStop-Loss Carriers
The claims that reach your layer, reviewed before they do.
High-dollar claims arrive at reimbursement with the price unexamined. Review before payment protects the loss ratio, and the determination is settled while there are still options on the table.
For stop-loss carriers
