Highlight Health is redefining cost containment for self-funded health plans, participants, and stop-loss carriers. We save money for plans and participants, while assisting plan sponsors in fulfilling their fiduciary duties. We are an independent, nationally recognized healthcare cost containment company that uses innovative technology and sound industry knowledge and experience, to drive success. Our combination of expertise and technology sets the industry standard for independent healthcare cost containment and guidance services.
A $100,000 claim can stress some self-funded plans, yet more and more claims exceed a million dollars. Even when a claim is covered by stop loss, the self-funded plan ultimately pays the price. Fraud, waste, abuse, overbilling, and overpricing make large claims bigger than they need to be.
We work for self-funded health plans and we don’t have conflicting contracts that prevent us sharing all the cost containment strategies appropriate to the specifics of each claim.
We have a people-first approach to technology. Our technology is powered by our subject matter experts. Our experts sign and defend our work.
Our clients save money and gain satisfaction from being responsible fiduciaries of plan funds. Through Highlight Health they gain the ability to identify fraud, waste, abuse, overbilling, and overpricing. Most of our fees are based upon a percentage of savings, guaranteeing alignment of interests and return on investment.
Highlight Health’s team includes healthcare billing industry experts, technologists, and customer concierges, who work as a team to guide our clients through every step of reviewing, analyzing, and paying large healthcare claims. We help you understand the nuances and complexities of healthcare billing and claims processing, and our industry-leading security processes keep your data safe along the way.
Highlight Health’s expert team knows healthcare claims and self-funded health plan management, from itemized bills to the plan’s evolving obligations under ERISA and HIPAA.
Highlight Health has particular expertise in analyzing the new healthcare transparency machine readable files (MRFs). These files provide unprecedented access to price validation.
At Highlight Health we use multiple cost containment strategies. Our partners
have the flexibility to select the strategies that work best for them.
We bring healthcare billing expertise and a deep understanding of the governing laws, rules, and regulations.
We reduce costs before claims are paid. “Pay and chase” is never the best strategy.
We win when our partners win. Our payment model is based on success.
Our reports and work products are detailed, supported with citations, and defensible.
It’s much easier to pay the right amount upfront, than to later collect on an overpayment! Highlight Health therefore mostly reviews, edits, and reprices pre-payment claims. We focus on the large medical claims that may disrupt our clients’ financial health. Our clients set their own threshold for a “large claim”.
Highlight Health contracts directly with the self-funded health plans and their stop-loss carriers. We don’t contract with organizations who might restrict the advice and services that we offer our clients. Our founders have academic and legal backgrounds, and we are independent and unconflicted. We can find, obtain, and defend savings in places where competitors too often do not, and we serve our clients relentlessly.
Let us show you how our solutions will bring value to you.Health plan sponsors have a fiduciary duty to run the plan solely in the interest of participants and beneficiaries, and for the exclusive purpose of providing benefits and paying plan expenses. Yet, few fiduciaries have adequate training in the complexities of healthcare payments. Furthermore, for decades, plans did not have access to healthcare prices and detailed payment data. Therefore, even zealous fiduciaries could not fully perform their duties.
Recently passed laws and regulations have brought transparency to network negotiated prices and given plans access to their own data. Fiduciaries are now able to fully perform their responsibilities but need knowledgeable and experienced advisors. There is also an increasing legal expectation that fiduciaries must perform their responsibilities, as evidenced by recent court cases against health plan fiduciaries.
Healthcare billing and payment issues are complex, and the stakes are high. Healthcare costs are the second largest line-item for almost every company in America. Highlight Health can help, by providing Plan fiduciaries with independent, expert advice, and defensible healthcare cost containment solutions.
Highlight Health can be your go-to source of knowledge and experience for cost containment. Partner now with Highlight Health to see how we can become a long-term trusted advisor, guard your health plan, protect your company, and demonstrate a positive return on investment.
Partner with Highlight Health today to protect your health plan, safeguard your company’s finances, and demonstrate a strong return on investment.
Highlight Health serves self-funded plans, their participants, and stop-loss carriers who want to reduce healthcare costs and fulfill fiduciary responsibilities. We work closely with our clients’ third-party administrators (TPAs), program managers, brokers, and consultants. They are integral to our success. Likewise, TPAs, program managers, brokers, and consultants have found that Highlight Health can be integral to their success and routinely introduce us to new clients.
We serve and work side-by-side with:
Our clients all share a commitment to reduce healthcare costs for the benefit of their plans, their participants, and the U.S. healthcare system. Individually and collectively, they are change agents.
Our clients include health plans sponsored by employers, unions, associations, and government entities. Plan participants live in every part of the United States and work a full range of jobs in many different industries.
