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Tag Archives: Self Insured

  1. Commentary – Expect Gulf Oil Slick Claims To Be Extensive And Impact Multiple Lines Of Business June 5, 2010

    Posted in Commentary, My SPOT.

    We still do not truly understand the entire impact from a claims perspective of the tragedy that has unfolded as a result of the Deepwater Horizon rig accident in the Gulf of Mexico. Losses are being estimated in the $30-$40 billion range with only a fraction of that number covered by insurance. What has recently been reported, however, is an increase in premiums for offshore energy coverages. What is next? No one really knows. The Claims SPOT comments on the some of the issues facing the industry.

    2 comments
  2. Medicare Secondary Payer Allows Direct Data Entry For Small Reporters Of Claims June 2, 2010

    Posted in Medicare Secondary Payer, SPOT on Ops.

    A new change to the Medicare Secondary Payer reporting will allow those entities with a small number of reports the ability to key in individual claims. This will alleviate the need to create, test and manage a data feed. While not without limitations, the news should help those smaller reporting entities that had been struggling with the onerous requirements. The method is limited to those reports that have less than 500 reportable events in a year. Read more about the changes in today’s post.

    1 comment
  3. How Do You Effectively Manage A TPA? Speak Up And Be Active! May 20, 2010

    Posted in Best Practices.

    Tweet Become The Squeaky Wheel To Actively Manage TPA Outcomes As claim practitioners, most of us are familiar with what to look for when we shop for a third-party claim administrator (“TPA”).  One recent discussion on this blog cited such elements as claims systems, data reporting capabilities, and quality control (6 Essential Elements When To […]

    3 comments
  4. 6 Essential Elements To Explore When Choosing A Third Party Administrator April 27, 2010

    Posted in Due Diligence, SPOT on Ops.

    A Third Party Administrator (TPA) is often the best way to handle claims for an organization. Many self-insured and captives choose to outsource their claims instead of creating their own internal operation. Whether to get expertise in a particular areas, or not wanting to invest in the infrastructure to build a claims department, using a TPA can be a smart business decision. So what make a good TPA and what should you look for? In order to find out you must conduct a comprehensive due diligence of the TPA you are about to hire. This is especially the case when that TPA will be holding and managing your claim dollars. Besides understanding the financial strength and capabilities of the TPA, it is also important to know whether they will be able to meet your data needs, provide consistent claims handling, and work to lower costs where they can.

    In this weeks post I address 6 essential elements, and questions, that should be explored as part of any due diligence when selecting a TPA

    4 comments
  5. Warning – Medicare Secondary Payer (MSP): Government sends strong message and goes after non-compliance February 3, 2010

    Posted in Medicare Secondary Payer, SPOT on Ops.

    If you are an insurance company or self-insured, and make payments on liability or workers’ compensation claims, be aware that the Federal Government has filed a lawsuit signaling their intent to be aggressive in seeking reimbursement. As reported in Business Insurance, this “case breaks new ground because CMS simultaneously named insurers, settlement beneficiaries and plaintiffs attorneys all in one lawsuit.” This case should alert all that if you make a payment on an injury claim, and fail to let the Government know about money they should be collecting, they will come after you.

    2 comments
  6. A checklist of the 8 critical issues to be concerned about when self-managing claims January 25, 2010

    Posted in SPOT on Ops.

    You self-insure, but how well do you manage claims? Companies make decisions to self-insure their risks for a variety of reasons from financing to claims control. Regardless of the reason, when handling claims in-house it is important to manage those claims in an organized manner to protect company assets. Insurance and reinsurance companies use loss experience to determine what to charge for coverage as well as how much coverage is needed

    1 comment