ARC Employer Plan Review Process

ARC Employer Plan Review Process

Initial Meeting with Client-
-Review our Services and Platforms;
-Overview of ERISA self-funded plan audits

Phase 1: Review and analysis of ASO documents and/or TPA contract
– Review the monthly run report-2 years Rx monthly run reports-2 years Form 5500 -Review Eligibility files and protocols reviewed
– Time estimate: 20 working days

Second Meeting– (assuming above files have been received prior to second meeting)
• ARC reviews the provided information •ARC provides a report on projections of data audited • ARC reviews the proposal with the client • The proposal will specify details of projected over-expenditures • ERISA and ACA guidelines
• Options to protect the self-funded Employer Health Plan prospectively

Overview of Review, Refund & Recovery Protocols

  • If the Proposal is acceptable by the Client:
  • ARC will assist the client in accessing all the Plan Claims Data files
  • ARC and our platforms run a 100% review of every claim for at least two years
  • After the Review-Audit the client is provided with a full report. – Time estimate: 30 to 60 working days; however it ASO does NOT provide claims data in
    a timely fashion this could extend the time required

• Strategy and supporting tactics are discussed to assist the client with options to pursue a recovery of your dissipated health plan assets
• If necessary, legal tactics are provided. This would apply especially if ARC uncovers undisclosed markups and ERISA/ACA prohibited transactions
• After a recovery is started and/or completed, the MCR platform is installed
– Time estimate: 45 working days to 60 working days depending on the ASO or TPA structure and compliance with ERISA for recovery

  • MCR prevents and mitigates future overpayments from occurring
  • An ERISA/ACA dashboard can be installed for the HR department. This affords that your plan remains compliant with Federal and State applicable regs

Consulting along with your benefits partners we can make recommendations about other options for your plan-transparency and cost containment tactics

Any questions please email us at