Shift Shapers Podcast

25 Jan 2021

Ep #346: Updated Plans Need Up-to-date TPAs – with Kari Niblack

David Saltzman 0 Comments

This week’s episode features a conversation with Kari Niblack, CEO at ACS Benefit Services. TPAs now offer novel and customizable plans while still providing traditional services like manual adjudication and appeals. At the same time, TPAs now assist smaller companies who are on level-funded plans to take the leap into partially-self-funded plans. In 2021 and beyond, data and transparency must be used to help clients make more informed decisions on the plans that are right for them.

What You’ll Learn From This Episode:

  • 01:44 Manual adjudication safeguards client money
  • 06:04 Handling appeals and offering highly customized solutions
  • 09:34 Defining and explaining plan documents
  • 13:06 Resurgence of level-funded plans
  • 16:49 Using data for transparency and improved member plans

Quotes:

03:48 “We consider ourselves to be stewards of their monies and take that very very seriously. So we’re going to put a lot of extra attention and focus on being that that claim has gone through all the appropriate levels of authority before we release those monies.”

04:46 “If you’re having an inpatient surgery, we want to be sure that what we call the CPT code, which is a technical term, but basically have the hospital’s billing procedures, we want to be sure that there’s not what we call unbundling.”

10:30 “[The plan document] basically is the, we call it the 4 corners of the document that basically sets out all of the benefit structures, what’s covered, what’s not covered, definitions of terms, all of those good things.”

14:08 “With a well-designed, level-funded plan, there is the ability to keep reserves versus if they are fully-insured they do not. So that’s a huge change in the industry.”

21:00 “Call our company and say, ‘I want to see this piece of data as raw as you can make that for me or as thorough as you can make it or as transparent as you can make it for me because then we’re going to make x, y, z decisions.”

Listen to the Full Interview:

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