Highlight Health partners with insurance brokers, consultants, third party administrators (TPAs), and program managers to help them build and fortify the cost containment strategies that they offer their self-funded health plan clients.
We are in tune with our partners and always want to work in harmony. Therefore, our work focuses on the most costly claims that often account for an outsized percentage of medical spend.
The largest 1% of medical claims account for 40% or more of medical costs and are the highest cost driver of self-funded health plans. The 1% encompasses most inpatient hospital claims, some outpatient hospital claims, and occasional professional claims.
Large claims have a massive impact
Total Number of Medical Claims for Billed Charged Over $25,000
Total Allowed Amount for Medical Claims Over $25,000
Claims Analysis for Northeast Public Employer with 25,000+ Plan Participants, Calendar Year 2023
Prior to 2021, there were little resources available to plan sponsors to help them ensure large claim payment integrity and properly contain costs. That changed with the passage of the Consolidated Appropriations Act of 2021 (CAA) and the advent of price transparency.
Highlight Health addresses payment integrity in medical billing with confidence.
- We provide a unique and tailored solution that generates immediate first year savings for your clients.
- We leverage data and results to help your clients get substantially better results, and accordingly, better renewals.
- We deliver higher-performing plans, and we drive substantial savings and return on investment for our clients.
We understand the complexity and challenges faced by TPAs and have built our platform to make integration easy.
- We handle plan document modifications and drafting.
- You can send us claims data via various pathways.
- We are agnostic to data exchange and can handle different platforms and systems.
- We manage health provider interactions.
Our results benefit you and your clients.
Let’s Serve Plans Together