ClaimInformatics and Detego Health restore fiduciary trust with truly independent pre-payment claim review. This eliminates TPA conflicts, reduces medical waste, and ensures ERISA-aligned payment integrity.

Major networks are finally shifting on data sharing. The excuses are gone. It is the employer’s fiduciary responsibility to demand access. If a carrier or vendor refuses, and the pattern continues, you must replace them because their obstruction causes you to breach your fiduciary obligations.

At ClaimInformatics, we help plan sponsors identify hidden fiduciary risks. Before your renewal, we are offering a complimentary ASO Agreement and SPD Analysis, valued at $5,000, to the first 15 self-funded entities who schedule a call this month.

Courts are applying the same fiduciary standards used in 401(k) fee litigation to health plans.

The carrier controls claim audits. Claim reviews are fiduciary responsibilities under ERISA. Understand why reviews are crucial for safeguarding plan assets.

When claim administrators audit their own networks, conflicts arise. Independent payment integrity ensures ERISA and CAA compliance, protecting plan sponsors, members, and fiduciary accountability.

As renewal season unfolds, fiduciaries face a critical opportunity to align contracts with their ERISA duty: act solely in the interest of participants and prudently manage plan assets

As renewal season approaches, fiduciaries should carefully review contract terms and challenge “mandatory” payment integrity programs that shift costs back onto plans. If you’re being asked to pay to fix what you’ve already paid for, the time to push back is NOW!

Today, self-funded health plans are entering that same era of scrutiny. Just as 401(k) plan sponsors had to adapt to fiduciary standards, employers offering self-funded healthcare must now comply with ERISA and new mandates under the Consolidated Appropriations Act (CAA 2021). Those who fail to evolve risk legal action, regulatory enforcement, and financial harm to both the plan and its participants.

Excited to see Employee Benefit News highlighting Stephen Carrabba, ClaimInformatics, Inc., and Jamie Greenleaf, AIF, CBFA, C(k)P, Fiduciary In A Box, contributed article entitled "Benefits Think: When 'shared savings' really means shared conflicts." The article highlights that shared savings may sound like a cost-containment measure, but they often mask conflicts of interest. The Tiara Yachts case shows why fiduciaries must demand transparency, independent oversight, and tru

At ClaimInformatics, ClaimIntelligence™ delivers payment integrity across Pre-Pay and Post-Pay, with PAIR™ for historical lookback and Ongoing Monitoring of new claims, while FOCUS™ provides the fiduciary oversight layer, including CLEAR™ contract review, to help plan fiduciaries safeguard participant assets, enforce SPD protections, and achieve ERISA and CAA compliance.

Florida Women's Care, one of the largest women’s health providers in the state, revealed troubling allegations of systematic overbilling and upcoding designed to pad private equity profits. These practices come at a steep cost to patients and health plans.