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,...

At ClaimInformatics, our FOCUS™ platform (Fiduciary Oversight, Compliance, and Utilization Safeguard)—powered by PAIR™ technology, Ongoing Monitoring, Pre-Pay Payment integrity and Recovery Services, and advanced analytics helps plan fiduciaries safeguard participant assets, enforce SPD protections, and achieve compliance with ERISA and the Consolidated Appropriations Act (CAA).

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.

Fiduciaries need the people, process, and technology to ensure plan oversight. After nearly a decade of litigation , Aetna Life Insurance...

We’re proud to see PLANSPONSOR continuing to advance the fiduciary conversation for employer health plans. In a recent article, Fiduciary...

Without transparency and access to THEIR data, plan sponsors risk breaching fiduciary duty under ERISA and the CAA. The 2025 Pulse of the...

On September 3, 2025, the U.S. Department of Health and Human Services unveiled a major enforcement initiative targeting practices that restrict patient access to their own electronic health information (EHI).

2020 was a landmark year in healthcare – and not just because of Covid-19. Over the last 18 months, multiple government agencies have...