Our standard data request includes Medical Claim Header, Medical Claim Detail, Pharmacy Claim Header, Pharmacy Claim Detail, and Coverage Information. No PHI data is required to process our analysis.

No, we do not interact directly with the member. However, a member may receive a reimbursement from the health plan on an overpayment after finHealth's analysis has determined an error or improper billing.

finHealth provides real time, ongoing analysis of all medical and pharmacy claims including pre and post-payment. Audits are retroactive, typically done on a sub-set of claims and executed annually or less frequently.

finHealth undergoes an annual HIPAA Risk Analysis and compliance review with a third-party assessor to ensure we are HIPAA compliant. The HIPAA Risk Assessment methodology is based on NIST 800-30 and the Office of Civil Rights (OCR) suggested methodologies. The annual assessment report is available on request. We use a hosting provider which has HITRUST, SOC, ISO and is HIPAA compliant.

An employer's commitment to their fiduciary duties is the key ingredient for success and provides them with their right to request their own data. finHealth works closely with our clients to provide recommendations, strategies, and templated email requests which have proven effective in receiving complete and accurate claims data.

finHealth works closely with innovative self-insured employers as a trusted advisor in safeguarding your healthcare dollars. Our clients share a common vision in identifying and eliminating the fraud, waste, and abuse that exists in our healthcare system.

Yes, when issues or errors are detected, finHealth will collaborate, coordinate, and negotiate with our client's carrier/TPA/PBM until recovery or resolution.

As the industry leader, finHealth is at the forefront of helping self- insured plans uphold their fiduciary responsibilities to their plan members according to the recently enacted Consolidated Appropriations Act of 2021. There is growing litigation over data access, payment accuracy, and fiduciary responsibilities. The Department of Labor is increasing its regulatory focus on raising governance standards around employer-sponsored health plans. finHealth helps our clients: • Safeguard health plan assets for members and their organizations • Hold carriers / TPAs / PBMs accountable for strong performance • Avoid lawsuits based on lack of fiduciary governance and oversight • Fund health plan programs to improve member health / boost employee engagement Our work has helped self-insured plans address new protections like the No Surprises Act and ensure their carriers are implementing the correct policy interpretations to process claims -- often, they are not and this represents money that groups are overpaying. Groups need to demonstrate that they are paying fair and reasonable prices as a plan fiduciary, especially in light of emerging employee class action lawsuits.

Employers must meet ERISA standards as part of their fiduciary responsibilities as a health plan sponsor. Self-governance does not meet the ERISA standards for fiduciaries. finHealth is happy to coordinate alongside any TPA-contracted payment integrity services and identify errors and issues above-and-beyond what existing systems flag. TPA-contracted services have an inherent conflict-of-interest because the TPA is their customer, not the plan. It is advised that self-insured plans hire an independent data analytics company that is not affiliated with your existing carrier, service provider, or consultant.