What Is a Pharmacy Benefit Manager (PBM)? A Guide for Employers and Benefits Brokers
Prescription drug spending continues to be one of the fastest-growing components of healthcare expenses for many employers. If you’ve been asking what is a Pharmacy Benefit Manager, the short answer is this: a Pharmacy Benefit Manager (PBM) administers prescription drug benefits for an employer health plan by managing pharmacy networks, processing pharmacy claims, developing formularies, […]
What Is Reference-Based Pricing? A Guide for Employers and Benefits Brokers
If you’re asking what is reference-based pricing, the short answer is that it is a healthcare reimbursement strategy commonly used with self-funded health plans. Instead of relying solely on negotiated provider contracts, reference-based pricing reimburses healthcare providers using a predetermined benchmark—often a percentage of Medicare reference pricing. This approach can provide employers with greater healthcare […]
What Does a Third-Party Administrator (TPA) Actually Do?
If you’ve ever wondered what does a third-party administrator do, the short answer is this: a third-party administrator (TPA) manages the day-to-day administration of employer health plans and workers’ compensation programs. Rather than simply processing claims, today’s TPAs coordinate benefits administration, medical claims processing, customer service, reporting, vendor relationships, and cost containment while helping employers […]
Cost Containment Strategies for Employee Health Plans
Healthcare expenses continue to be one of the largest and fastest-growing costs organizations face. Employers across industries are managing increasing medical expenses, rising prescription drug costs, and evolving employee healthcare needs while trying to maintain competitive benefits programs. As a result, many organizations are evaluating ways to improve oversight, gain greater visibility into healthcare spending, […]
How Workers Compensation Claims Administration Works
Workplace injuries can occur in virtually any industry, from healthcare and education to manufacturing, construction, and public service. When an injury happens, employers must navigate a process that involves employees, healthcare providers, claims professionals, and regulatory requirements. This is where Workers Compensation Claims Administration plays a critical role. Many employers assume workers’ compensation claims involve […]