A form of self-insurance under which the employer pays administration fees to an insurer or other service provider for processing claims. The service provider takes on no risk in this arrangement.
An arrangement whereby an organization (usually an employer) hires an outside firm to perform specific administrative services, usually including claim administration, for a group health insurance program. The organization retains financial responsibility for paying claims. See also self-insured group insurance and third-party administrator (TPA).
An arrangement whereby an organization (usually an employer) hires an outside firm to perform specific administrative services, such as providing claim forms and processing claims, for a group health insurance program. The organization retains financial responsibility for paying claims.
The management services provided by a third party for an employer group that is financially at risk for the cost of health services. Management services may include claim payments, medical management services, and/or network access. This is a common arrangement when an employer sponsors a self-funded health benefit program.
Where one party provides only administrative or clerical services to an employee benefit plan. (Typically the employer is the administrator.) Another party acts as the trustee.
A type of contract in which the contracted organization provides only administrative or management services (e.g., claims processing, utilization review) but not direct treatment services, which are provided by the purchaser or by another organization.
An agreement between an insurer and a self-insured organization under which the insurer, for a fee, provides all the administrative services for the organization's health plan. These services might include, for example, enrollment, billing, eligibility, claims processing, and all other paperwork in relation to the health care plan.
A fee-based program in which an insurance company or other third-party administrator performs administrative, clerical or managerial services only and does not assume any risk. Services usually include claims processing, but also may include other services, such as actuarial analysis, utilization review, etc. Businesses or self-funded health plans may use an ASO.
Health care organization provides administrative support services only for a self-funded plan or startup MCO.
A relationship between an insurance company or other management entity and a self-funded plan in which the insurance company or management entity performs administrative services only, such as claims adjudication, customer service and membership processing and does not assume any risk. The self-funded plan assumes the financial risk for the claims.
A self-insurance arrangement in which an organization (usually an employer) hires an outside firm to administer the employer's health insurance program, but the employer retains responsibility for providing funds to pay claims. See also, self-insured group and third-party administrator (TPA).
A contract in which a third party administrator or insurance company processes claims for a self funded health plan
The services provided by an insurer, such as providing claim forms and processing claims, when the insurer is not the party funding the loss payments. Plan of insurance where an employer, which has fairly predictable claim costs, pays the claims rather than an insurance company.
The services provided by an insurer, such as providing claim forms and processing claims, when the insurer is not the party funding the loss payments. See also Self Funded Plan.
An arrangement whereby a self-insured entity contracts with a Third Party Administrator (TPA) to administer a health plan.
An arrangement under which an insurance company, for a fee, processes claims and handles paperwork for a self-funded group. This frequently includes all insurance company services (actuarial services, underwriting, benefit description, etc.) except assumption of risk.
An arrangement in which an insurer or other organization provides claims administrative services to a benefit plan but does not assume any of the risk or liability. Also known as administrative services contract.
An arrangement where an organization will perform specific administrative functions relating to healthcare programs such as claims processing for self-insured groups or third party providers/payers for a fee.
An arrangement under which an insurer or another third-party administrator contracts to provide specific record keeping and claim payment functions to a self-funded group insurance plan.
A type of contract with an insurance company or a third-party administrator that provides an employer solely with administrative support. It does not provide coverage for risk or insurance protection. The usual expenses covered include claims processing, plan design advice and printing benefit booklets. These services are usually entered into by large employers that can afford the risk of providing insurance protection with their own money.
