Employer healthcare data is Dark Data.

Healthcare is the second largest employer expense and claim costs continue to rise each year.  2 out of 3 Americans who obtain healthcare benefits through their employer are self-funded.

Self-funded employers basically write blank checks to their carrier/TPA, often on a weekly basis.  They trust that the net claim amount is correct and hope that they are serving the best interests of employees and their families.  Hope isn't an ERISA fiduciary strategy and trust isn't compliance.

C-suite executives carry personal liability for plan oversight, cost management, and participant protection. Class-action lawyers and the Department of Labor don't care that you hired someone else to pay the claims - the buck stops with you.  Unlike the pharmacy benefit that is widely discussed and relatively straightforward, your medical spend is a tangled web of layered complexity and warrants more attention.

The claims and financial data generated and stored by your medical carrier/TPA holds the keys to transparency and fiduciary oversight and the Consolidated Appropriations Act of 2021 gave you the legal right to possess all of this data.  So, it should be as simple as asking your carrier to send over the data...it's not.

Carriers do not want to share this data for obvious reasons, so they prey on the inexperience of employers and hide behind ASA contract language to withhold it entirely or offer their "standard" data extract that is missing several key pieces of information.  Your ERISA obligation requires that you demand complete transparency, so to obtain all of your data, you need to request all of your data.

Dark Data Health Insights spent two decades analyzing full medical claims datasets behind the firewall of 37 of the most prominent medical carriers in the U.S. (the "BUCAs").  We know what data is truly available and how to ask for it.  Let us help you best negotiate with your carrier and obtain all data/information needed to understand your spend, protect your members, reduce your risk, and control your costs.