MedCity News reports on the latest in a series of lawsuits by large self-funded employers against national carrier administrators. These cases place a spotlight on health plan administrators that do not provide employers access to their medical claims data, in violation of the Consolidated Appropriations Act of 2021.

“The No Surprises Act prohibits plan sponsors from entering into any network, pharmacy, plan administration, or service agreement that includes a provision preventing them from getting access to their plan’s de-identified claims data and provider cost and quality information,” said Caroline Fraker, MedBen Senior Vice President and Chief Compliance Officer. “But the law goes beyond just removing certain provisions from these agreements… it requires that plan sponsors be given direct access to their own plan data.”

Fraker also noted that “MedBen has always provided this data to our clients, and has spent the last six months confirming that all the agreements we bring to clients are compliant with the No Surprises Act.”

As the article notes, for employers to perform their fiduciary duty to provide the best medical benefits at the best cost – and ensure that their TPA is paying claims accurately and fairly – requires access to all their claims data. For that reason, MedBen places an emphasis on client access and data transparency.

Here’s the bottom line: With MedBen, you don’t have to worry about this, because we recognize that it’s YOUR claims data. We are dedicated to providing you complete access to your data, while at all times respecting the privacy rights of plan members. 

Access to your claims data comes from:

  • Our MedBen Analytics employer dashboard, complemented by downloadable reports that draw from your complete claims database.
  • Monthly reporting.
  • Quarterly plan reviews.

We can also provide customized reports with de-identified data to address your specific information requests.

Should you ever have a question about any aspect of your claims data, do not hesitate to contact your Account Management team.