Specific Stop-Loss Reimbursement Integrity Desk
A narrow historical closeout for self-funded plans where medical administration, pharmacy data, and specific stop-loss are split or changing. Public complexity is only a qualification signal; the first step is confirming that an incumbent does not already own the control.
Version policy/application/endorsements, claims basis, deductible/lasers, reimbursement percentage, covered Rx, maximums, deadlines, and run-out terms.
Normalize supported medical and covered pharmacy paid claims by member and policy period.
Tie deterministic expected reimbursement to submissions and carrier payments with source-linked exceptions.
About $3,500 clean/small; $7,500 transition/run-out complexity. Pricing is a hypothesis, not market validation.
No medical necessity/coding review, contested eligibility/coverage interpretation, COB/subrogation decision, denial appeal, insurance advice, carrier negotiation, or aggregate stop-loss certification. Unresolved predicates suppress reimbursement exceptions.
No identifiable member claim upload is available here. Demo work uses synthetic or customer-attested HIPAA-deidentified data. Live identifiable member intake remains disabled until an executed BAA and operational security/privacy stack exist.
Controlled benchmark fixtures demonstrate software behavior; they do not establish real-customer recovery rate or reviewer time.