Spoiler alert: the answer is yes.
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With PMBA PSP, self-funded employers now have the opportunity to not only level the playing field, but pay substantially less than their fully-insured counterparts. This is true even of many in-network claims.
The unique repricing mechanisms utilized by PMBA’s Plan Sponsor Protection (PSP) service can be applied to in-network claims, transforming the cost containment paradigm for our self-funded clients. PMBA PSP is revolutionizing cost control for the self-funded market.
The foundation of our services for all clients is claims repricing and analysis. PMBA’s expertise in comprehensive healthcare claims analysis is unparalleled. We examine every claim from multiple angles to ensure that our clients never overpay. The process behind PMBA PSP ensures that every claim:
Saves our clients millions of dollars and provides an essential compliance service.
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Self-funded groups have a long history of overpaying for member care and for decades were unable to do much about it. Thankfully, with the advent of the CAA and the elimination of gag clauses in network contracts, they are newly empowered to seek and receive historical claims and payment data. PMBA maximizes the value inherent in this new age of transparency, offering post-payment review of single claims and audits of historical claims data.
Under ERISA, your group's Summary Plan Description (SPD) is the legal document that governs everything about your Plan. PMBA’s wealth of legal, regulatory and claims expertise helps our clients develop the best possible SPD. A PMBA SPD protects your Plan’s fiduciary interests and secures the legal basis for your Plan to pay claims at the lowest rates available, protecting the financial health of your Plan and its members.
Has your Plan already started its benefit year?
Not a problem! PMBA also develops Summary Material Modifications (SMM) for our self-funded clients. SMM’s can be instituted at any time during a benefit year.
