Archive for December, 2011

SRP Announces Plan Doc Builder for TPAs and Brokers of Healthcare Plans

December 15th, 2011 No comments

Legal and subrogation recovery firm provides new software
to generate Health Plan Documents on demand

Willow Grove, PA / December 14, 2011 / Strategic Recovery Partnership (SRP) Inc. today announced the availability of Plan Doc Builder™, a subscription service that allows Third Party Administrators (TPAs), brokers, and other users to easily generate Health Plan Documents on demand. Replacing outdated software tools and the need for expensive outsourcing, SRP’s Plan Doc Builder is available at fixed, affordable licensing rates with no initial subscription fees.

Employers require Health Plan Documents containing clear language about available benefits that are compliant with the Employee Retirement Income Security Act (ERISA), the Patient Protection and Affordable Care ACT (PPACA), and other regulations.

Created specifically for the generation of Health Plan Documents including Prescription, Dental, Vision and Cafeteria benefits, SRP’s Plan Doc Builder allows users to:

· Easily collaborate with experts to produce customized, attorney-approved Health Plan Documents

· Create or clone Health Plan Documents in an intuitive web interface

· “See as you go” by continuously reviewing and updating content during document preparation

· Generate thorough, easy-to-read, and compliant Health Plan Documents and Summary Plan Descriptions (SPDs), with Regulatory and Benefit amendment capability.

“Ongoing client collaborations and our experience with health plan document preparation and compliance enabled us to develop a fully automated approach for in-house users at competitive rates,” explains Robert A. Marcino, Esq., principal at Strategic Recovery Partnership. “We are excited to offer a better tool through Plan Doc Builder, especially to TPAs and brokers.”

SRP’s web-based Builder is flexible and allows one or multiple users to modify content during document generation. TPAs can clone documents, providing a significant shortcut when creating similar plans. Users can also leverage objective analysis and legal advice from SRP on approaches to current or new health plans.

TPAs and brokers can learn more, schedule a personal demonstration, and request a quote for affordable licensing rates by visiting

About SRP

Strategic Recovery Partnership (SRP) is a legal and claim recovery resource that provides Subrogation and Plan Document solutions nationwide to Third Party Administrators (TPAs), Stop Loss carriers, HMOs, and Fully-Insured Healthcare Plans. SRP delivers low-cost attorney representation with technical expertise—consistently achieving proven revenue streams for health claim payers. With nearly 20 years of experience, SRP has expertise with TPA claim and benefit practices, technical writing, plan consulting, and ERISA. SRP attorney review helps avoid the risks of noncompliance, including penalties from Department of Labor (DOL) audits, lawsuits, and insufficient understanding and inconsistent application of benefits by employers and administrators. For more information, visit

Media Contact:

Erin Flynn Jay
TME Communications for Strategic Recovery Partnership Inc.
[email protected]

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OptumHealth’s New Stop Loss Endorsement Already Approved By Twenty States

December 6th, 2011 No comments

OptumHealth has amended its stop loss contract to provide protection to self-insured plan sponsors who may face additional exposure resulting from changes in the claims appeal process under the Patient Protection and Affordable Care Act (PPACA).

The amendment, called an “extended liability endorsement,” is included in all new and renewal OptumHealth® stop loss contracts that take effect on or after January 1, 2012, subject to state approval. OptumHealth has received approval in twenty states to date, with more state approvals expected to follow.

Beginning in 2012, PPACA allows individuals whose claim is denied by a health plan through its internal claims review process to appeal to an independent review organization (IRO). A claim that is initially denied may eventually have to be paid by the health plan if the IRO overturns the denial.

Typically with most stop loss contracts, claims paid outside the time frame set out in the contract are not eligible for reimbursement. Under this new appeal process, however, payment on an overturned denial may be made months later, even beyond the benefit period in the stop loss contract. In such cases, OptumHealth will extend the paid date in the contract by up to 12 months.

“Many of our third party administrator clients have expressed concern about employers’ potential liability as a result of the new claims appeal process, said Scott Avery, stop loss product director of OptumHealth. “With our new policy endorsement, OptumHealth is helping self-insured employers to maintain their high quality stop loss protection while minimizing potential gaps in coverage.”

There are an estimated 1.3 external appeals for every 10,000 plan participants, and there will be approximately 2,600 external appeals in 2011, according to the US Departments of Health and Human Services, Labor, and the Treasury.

On average, about 40 percent of denials are reversed on external appeal, with the amount per reversed claim averaging $12,400. According to the government, $13.4 million in additional claims will be reversed by the external review process in 2011, increasing to $33.1 million in 2013.


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