Stop Loss Reviews
Stop-Loss Cost Containment Nurse Reviews: Precision Support for High-Cost Risk Projections
Hamilton & Archer specializes in providing expert stop loss cost containment nurse or physician reviews to support your self-insurance product. We help you understand your prospects and renewal high dollar claims risk with accuracy and efficiency. Our nurses and physicians bring deep clinical knowledge and payer-side experience, are versed on most current disease treatment and drug therapies to help mitigate risk and protect your bottom line, without adding unnecessary overhead to your operations.
We can provide your organization with single-source stop loss reviews, provide backup and surge support during times of high volume, or we can be your partner throughout the year to provide stop loss clinical review and cost containment support. With our guaranteed turnaround times, backed up with our service level agreements, we can ensure your organization is responsive and competitive.
Real Clinical Insight for Real Financial Impact
Our team works directly with insurance carriers, managing underwriters, reinsurers, third party administrators, employer groups, intermediaries/brokers and captives. By combining our deep medical and clinical expertise with our insurance industry experience, we are your partner in projecting and mitigating risk.
In addition to stop-loss clinical reviews, Hamilton & Archer also provides:
Reserves Assessment: protecting your reserves is critical to ensuring the financial health of your stop loss risk. We can help you project reserves and understand the drivers for high-cost claimants based on their current and past health status and utilization.
Consultation: we can consult or integrate into your actuarial and underwriting team. Clients have the option to include our nurse or physician experts in monthly or quarterly claimant review meetings, or tailor our consultation as needed for specific or catastrophic claims.
With clients nationwide, Hamilton & Archer Health Services has vast access to trending data, specialty drug cost insights and emerging therapies that impact your book of business. Protect your financial risk with expert clinical and medical review support; on budget, on demand, and always aligned with your business goals.
Hamilton & Archer Health Services is a member of the Self-Insurance Institute of America (SIIA) .
The Criticality of Stop Loss Containment
Stop loss containment is critical to the financial stability and operational integrity of any self-funded health plan or insurer. This role ensures that high-cost claims are thoroughly validated, accurately coded, and appropriately managed before reimbursement under the stop loss policy. A skilled reviewer identifies potential overpayments, duplicate charges, billing errors, or non-covered services that could otherwise lead to significant financial losses. By verifying clinical necessity and ensuring that billed services align with contractual provisions, a good containment reviewer protects both the plan sponsor and the stop loss carrier from unwarranted claim exposure.