Employer Access to Health Plan Data

Access can be a huge hurdle to overcome for many health plans. Providing quality employee benefits is dependent on harnessing the power of data, educating employees, and providing members with quality benefits that support better health outcomes. This is Part One in a series highlighting the importance of access to provide you greater confidence, clarity, and control of your health plan. 

Data serves as the bedrock of informed decision-making, providing the confidence needed to navigate the complexities of health insurance effectively. Through data analytics, organizations gain valuable insights into plan performance, claim drivers, and opportunities for improvement.  Employers can typically access their health plan claim data through their insurance carrier or third-party administrators (TPAs). Here are steps employers can take to access health plan claim data: 

• Contact the Insurance Carrier or TPA to inquire about accessing health plan claim data and request that reports be delivered regularly via an online portal or dedicated representative. 
• Review Contractual Agreements with the insurance carrier or TPA to understand the terms regarding access to claim data. Contracts may outline specific procedures or requirements for accessing and utilizing the data. 
• Ensure Data Compliance with all relevant privacy and security regulations when accessing and handling health plan claim data. This may include adhering to HIPAA (Health Insurance Portability and Accountability Act) regulations and implementing appropriate safeguards to protect sensitive information such as Personally Identifiable Information (PII) and Private Health Information (PHI). 
• Engage with a Sophisticated Advisor to help navigate the process of accessing and interpreting health plan claim data. Employee Benefit Advisors at W3 Insurance can provide valuable expertise and guidance to optimize the use of data in decision-making.  

By following these steps and leveraging the resources available through your insurance carrier, TPA, and W3 Insurance Employee Benefit Advisor, you can CONFIDENTLY access and utilize health plan claim data to inform strategic decisions and improve the overall efficiency and effectiveness of your employee benefit programs.