Reinsurance / Stop-Loss
Self-funded payers typically require stop-loss reinsurance to mitigate losses due to high dollar claims experienced by a single person, or by the entire group. Specific reinsurance and Aggregate reinsurance policies have particular rules that identify the covered services, and payment parameters for stop-loss reimbursement.
VISOVA’s Reinsurance contract management system allows you to define the stop-loss policy parameters for automated evaluation as claims are processed.
You have granular control to identify services that are applicable to reinsurance via plan definition or business logic.
Define Contracts by:
- Incurred From and Thru Dates
- Paid From and Thru Dates
- Run In From and Thru Dates
- Policy attachment points and maximums
- Client, Network, Payer, Plan
- Supports “Lasered” Member contracts
- Lives tracking
REINSURANCE REIMBURSEMENT PROCESSING
- Automatically apply and track carrier payments
- Post carrier denials
- Track outstanding requests for reimbursement