Cost Management & Risk Mitigation

Minimizing Risk and Exposure

When you launch a self-funded health benefit plan, you take on the risks associated with owning and paying for all claims that stem from that benefit plan. Fortunately, CoreSource has the solutions to help you minimize costs and mitigate risk by managing plan eligibility, high-cost services and diagnoses, prior authorization, and out-of-network referrals.

Eligibility - Research shows that 3% to 10% of enrolled dependents aren't actually eligible under most benefit plans. With each dependent costing an average of $4,750 each year, that's a potentially significant impact to your plan costs. We provide real-time eligibility updates to ensure your eligible members receive the care they need when they need it and work with you to resolve potentially costly eligibility discrepancies.

High-cost Services & Diagnoses - Not all claims are created equal. We review high-cost services to find billing errors, waste, and negotiated savings opportunities to save you and your members' money.  

Prior Authorization - We can work with you to recommend prior authorization on specific services—such as chemotherapy and dialysis—to ensure your members get the appropriate care in the most cost-effective setting.
Our team also helps secure the best reinsurance coverage options for your plan from A-rated stop loss carriers. We help protect you from catastrophic and unpredictable claims either from a single high-cost individual or your entire population. Our benefit plan sponsor protection eases your legal worries when it comes to disputes against your plan.

Bottom line: when it comes to self-funding and CoreSource, you can rest assured knowing you've got cost and risk mitigation experts on your side.

Managing Cost with CoreSource Edge

When it comes to keeping costs low, CoreSource Edge is the complete package. Our carefully crafted set of solutions gives you comprehensive cost-control well beyond what you'd typically get from other employee benefit administrators. In 2017, our clients saw a 45–50%* savings on their out-of-network claims.

Each individual component of Edge has a positive impact on savings, but when banded together, they become a powerful force for you and your employees. CoreSource Edge keeps your benefit plan administration costs in check by closing gaps and ensuring your money is being spent where it should be - resulting in maximized savings for your bottom line and for all members covered under your plan.

* Average gross savings, CoreSouce book of business, 2017

Network Access and Alternatives

With access to more than 50 national, carrier-based, and regional networks, your employees get great access to quality providers and deep discounts on healthcare services. CoreSource analyzes your workforce and finds the best network, or combination of networks, to deliver the most appropriate options along with the biggest discounts for plan members. In addition to our PPO networks, we can reprice your claims using our reference-based pricing models. With reference-based pricing programs offered by CoreSource, clients can potentially see a significant reduction in overall healthcare spend.

Whether you choose a PPO network or one of our reference-based pricing models, we can help you achieve hard dollar savings without sacrificing the quality of your coverage.