Medical Management Partner
Spectrum Review Services, Inc. (SRS), headquartered in Houston, Texas, is a national Medical Management Company with an excellent track record. Through their clinical experience, SRS is adept at managing client benefit costs while assuring the best possible medical care for employees. SRS is CPR’s strategic partner for the following services:
- Pre-Authorization of hospital admissions and continued stays for acute medical and mental health/substance abuse patients
- Outpatient and inpatient pre-authorization of selected surgical and high-cost diagnostic procedures
- Appropriate discharge planning
- Large Care Management
- Chronic Disease Management
- Data collection for diagnoses and provider profiles
- Health wellness and support program
Learn more about SRS at www.spectrumreview.com
Stop Loss / Excess Loss Coverage – Insurance purchased to provide protection against large catastrophic claims and against unexpected high utilization. The coverage reimburses the employer for covered claims in accordance with the terms of the coverage elected. Two types of stop-loss insurance are available: Specific and Aggregate.
Specific Stop-Loss Insurance – Protects the employer against the financial impact of large claims. Specific excess loss coverage establishes a stop loss amount (or deductible) per individual for the excess loss period elected by the employer.
Aggregate Stop-Loss Insurance – Limits the employer’s liability to a pre-determined amount for the entire insured group during a certain time period. To determine at what level the aggregate liability of the employer is, limited attachment factors are calculated. Benefits can be determined at plan year-end or on a monthly basis according to the type of coverage that is chosen to best meet the employer’s needs.
Expected Claims – The estimated amount of claims that will be incurred during the policy year, as well as claims payments for expenses incurred during that year but not reported until after the end of the year. Deviations between (Expected) and (Actual) claims can occur on a policy-by-policy basis.
Actuaries base expected claims estimates on their past experience, as well as on published statistical information regarding (1) the probability that individuals will incur medical expenses, (2) the plan design, and (3) the probable cost of these expenses.
Fixed Costs – These costs which are budgetable; typically based on the number of employees. They usually include administrative fees and premiums and exclude actual claims.
Excess Loss Period – Contracts are generally offered on an incurred and paid basis:
12/12 = incurred in 12 months and paid in 12 months
15/12 = incurred in 15 months and paid in 12 months
24/12 = incurred in 24 months and paid in 12 months
Here are some links to websites we feel may be helpful to you.
Health Care Administrators Association – Established in 1980, HCAA helps TPAs navigate a complex and ever-changing employee benefits landscape by keeping them educated and informed with the latest information.
Texas Association of Benefit Administrators – Established in 1983, TABA serves the business needs of owners and executives of third part administration companies engaged in providing services in Texas and to further the advancement of the third party benefit administrators profession.
Complete Health Systems, Inc. – Since 1990, CHS has been developing, installing, and supporting health benefit administration application software systems nationwide.
Self-Funding Success – Today’s health benefits landscape is more challenging for employers to navigate than ever before. Yet, there’s a reason why nearly 70 percent of employees who have health coverage in the U.S. are now enrolled in some sort of self-funded plan and why that number is growing — they work.
TX Department of Health – The Mission of the Department of State Health Services is to improve the health, safety, and well-being of Texans through good stewardship of public resources, and a focus on core public health functions.
WebMD – Provides credible information, supportive communities, and in-depth reference material about health subjects that matter to its users. A source for original and timely health information, as well as material from well-known content providers.
SBC Uniform Glossary – A glossary of health coverage and medical terms. This glossary has many commonly used terms, but isn’t a full list. Glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan.
Flex Administration – This site is dedicated to providing employers with the tools they need to successfully establish these written plans with SPDs at the lowest cost possible.