Stop Loss Claim Filing

Merging our team’s expertise with specialized stop loss technology to ensure seamless filing of stop loss claims on your behalf, instilling trust and confidence in what we do.

We differentiate ourselves from competitors who simply offer a standalone technology solution and leave you to navigate the process alone. Instead, our dedicated staff takes over the responsibility of executing stop loss claim filing on your behalf, ensuring a smooth and hassle-free experience for you.

Stop-Loss Claims Management

Supporting advanced claim analytics, integrated TPA & PBM data feeds, robust stop loss policy integration, eligibility verification and reporting, stop loss claims filing, stop-loss claims review and reporting.
Supporting even the most challenging stop loss contracts: aggregating specific, lasers, aggregate accommodation, domestic claim contracts, etc.
Leveraging aggregate reporting capabilities to ensure all fees are included in claim submissions
Reconciling claims and fees to aggregate reporting and stop loss reporting integrated into our platform
Healthcare Reporting is the driving technology used by the majority of the stop loss general agent marketplace
Our Team + Technology approach truly takes the workload off our of TPA clients
Processed oriented approach coordinates the timing of various TPA and PBM data file feeds
Notification process and Trigger reports are leveraged from Self Insured Reporting, our industry leading reporting & analytics platform
Book of Business tracking via dashboard

140+ TPAs & PBMs

Integrations via our Claim Reporting & Analytics Platform

Fee Inclusion

Accounting for the various fees to ensure claim inclusion

Team + Technology Approach

Our team takes over the work of executing stop loss claim filing on your behalf, ensuring a smooth and hassle-free experience for you.

Block Dashboards

Real-time, block of business reimbursements

Stop Loss

Optimization

Leveraging cost containment to impact to stop loss

Frequently Asked Questions

What is a stop loss provision?

A stop-loss provision is an insurance clause typically found in self-funded health insurance plans that limits the insured’s out-of-pocket medical expenses and helps to protect employees from burdensome medical expenses.

How does a stop loss work in insurance?

A stop-loss provision in insurance is a provision where an insurance company shares the financial responsibility for covered medical expenses. For example, an insured person may have a stop-loss limit of $15,000. If the insured person accrues a medical expense totaling $30,000, they would only be responsible for paying the first $15,000. The insurance company would pay the remaining $15,000.

When does an insured qualify for stop-loss coverage?

An insured qualifies for stop-loss coverage when their medical bills go above the stop-loss limit specified in their insurance policy. At that point, their insurance company will pay a larger portion of their bills, protecting them from financial hardship as a result of burdensome healthcare bills.