In-House Legal/Compliance

Employee benefit plans are governed by an increasingly diverse number of state and federal regulations, and with Health Care Reform, new rules are on the horizon. Plus, those you may already be familiar with can change.

Higginbotham helps you interpret and comply with new and emerging rules under Health Care Reform legislation, ERISA, HIPAA, COBRA and many other relevant regulations. Not only do we proactively communicate new legislation, regulations and upcoming deadlines, we reactively address your compliance concerns and special circumstances.

Many employers rely on their health plan broker to keep them compliant. Higginbotham offers you the support of your broker as well as our dedicated in-house legal compliance consultant. We monitor legislative activity to explain the impact of new rules on your benefit plans and provide assistance to audit your documents and policies for vulnerabilities with the direction you need to remain compliant.

Higginbotham does not offer legal advice.

Compliance Check

We help you control risk and limit liability by reviewing your compliance in 20 key areas: loss control, human resources, employee benefits, workers’ compensation experience modifier, workers’ compensation claims review, risk transfer, replacement cost/building ordinance, business income, EEOC, employee manual, FLSA, FMLA, IRCA, records retention, sexual harassment, COBRA, HIPAA, policy provisions, Section 125, ERISA/SPD and OSHA.

ClaimReturnTM Services

According to the American Medical Association (AMA), commercial health insurance carriers have an average claims-processing error rate of 19.3 percent. The AMA also estimates that eliminating health carrier claim payment errors would save $17 billion (AMA press release, June 20, 2011).

Higginbotham offers client access to ClaimReturn, a company that works with employers, administrators and carriers to recover overpayments to medical providers and reduce health insurance costs related to claim payment errors.

Over the past 25 years, the ClaimReturn team of experts has performed compliance-centered examination of records for small organizations, Fortune 100 companies, unions, MEWAs and federal and state health plans. Its unique approach and expertise provides you with a comprehensive compliance analysis combined with a review of every single medical claims transaction. ClaimReturn identifies improper payments and recovers dollars lost due to errors in benefit claims administration, provider billing, application of network fee schedules, industry payment guidelines, duplicate payments and more.