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Stop-Loss Reporting


HCRM provides aggregate and specific reporting for insurance carriers providing Administrative Services Only (ASO) administration to self-funded employer groups. This service was initially provided to brokers who must provide these reports to stop-loss carriers because the ASO are unable to create them. These reports are costly for brokers to produce and carry significant concerns for electronic security and privacy.

Additionally, employer health plans need to include pharmacy costs in their stop-loss coverage due to the rise of high cost, biologic drugs that often equal major surgeries in annual costs. Integrating pharmacy data with medical claims are usually difficult because PBM’s is using different layouts, formats and member IDs than the ASO administrator. Because HCRM collects, normalizes and validates eligibility, medical claims and pharmacy claims for predictive modeling, the creation of aggregate and specific reports that combine both at the member level is simple.

HCRM operates a secure HIPAA and HITECH compliant data center and provides accurate, secure stop-loss reporting for our clients.

HCRM is your single source for data management and claim solution and will provide:

  • Employers weekly or monthly stop loss claims filing direct to carrier
  • Automated integration of medical and Rx claims
  • Expedited stop-loss reimbursement
  • Elimination of manual check run calculations
  • Elimination of back-end claims reconciliation
  • Enhanced reporting capabilities