Letter from the President
 We're in this together...

Linda Ludwick, Mountain States Administrative Services

As the years have passed in our TPA, we have developed a mission statement, created our core values and developed all of our marketing materials to support our "vision."  All pieces immaculately put together to communicate why we are a great TPA.  

This past week I had the opportunity to work with a company we are looking at doing business with. Their slogan: "We're in this together."  Simple words that packed a big punch!  

Building and communicating trust with your key stakeholders is a way to fuel the success of your business.  Developing trust in your current business environment and supporting it with the leadership actions required are critical.  Assuring your principals and standards allow you to get into the trenches with your clients is imperative.

A difficult economy often results in a return to traditional management approaches and concerns.  It is in these times that there is a significant and critical need to build and maintain trusted business relationships.  Maintaining and growing our business must not only revolve around emulation of the BUCA's  but requires the retention of our loyal customers and the retention of high performing employees.  Don't take either for granted.  Let them all know, often, we are in this together and we are there for the long run.

For those of you who did not attend the HCAA Forum you missed one of our best conferences.  One CEO of a large company told me it was the best conference he had ever attended anywhere!  Our surveys are in from the conference and they are more than favorable.  Many thanks to everyone who worked so hard to put together another great event!

Don't forget to reserve July 16- 18th for the TPA University "Executive Blueprint for TPA Operations"!  We will be hosting the conference at the Hotel Nikko in San Francisco.

My best to all of you and remember, we are ALL in this together.  

Best regards, Linda

 Record Attendance for
 Executive Strategy:
 2008 Executive forum

Over 180 people attended the 2008 Executive Forum at the Venetian Hotel & Resort in Las Vegas on February 6-8, 2008.  This year's theme was "Executing Strategy: A TPA Blueprint for Growth, Change and Success."  The event was a huge success with record turnout - but don't take it from us - listen to what the attendees had to say:


"HCAA's Executive Forum is the premier "Think Tank" for the self-funded industry. Competitive walls are broken down and real dialog exchanged between industry colleagues, with the shared goal of better positioning TPAs within our markets."
- LynAnn Henderson, Employee Benefit Management Services, Inc.

"This is the best conference that I attend! I enjoy seeing all the folks that have become my extended family."
- Linda Wikler, Emdeon Business Services

"A timely and concise overview of issues facing Executives in the TPA industry. Recommended for TPA management who wants to be informed of industry trends."
- Dirk Visser, Allegiance Benefit Plan Management, Inc

"HCAA presents an opportunity to network, learn, and socialize with others in our industry that is second to none." 
- Ron Peck, The Phia Group LLC

A special thank you to our 2008 Executive Forum sponsors

Check out photos from this year's event


 

 SAVE THE DATE!

"Executive Blueprint for Operations Excellence"

6th ANNUAL TPA UNIVERSITY
July 16-18, 2008
Hotel Nikko, San Francisco

TPA best practices for current and future leaders within your organization!

ALERT:  There is a city-wide event being held the same week as our conference.  Be sure to make your hotel reservations now!

Make your hotel reservations now
by calling (800) 248-3308 or (415) 394-1111.

Be sure to reference "Health Care Administrators Association" to receive the group rate of $245.

SPONSORSHIP OPPORTUNITIES AVAILABLE! 
Click here for more information.

 New Medicare Secondary
 Payer Reporting Requirement

By John Barlament, Esq.

The Medicare, Medicaid and SCHIP Extension Act of 2007 (the "Act") imposed a new Medicare secondary payer ("MSP") reporting requirement on group health plans. Beginning in 2009, insurers and third party administrators ("TPAs") are required to collect from plan sponsors and plan participants information to identify situations where the group health plan is or has been the primary plan with respect to Medicare.  This information must then be submitted to the Department of Health and Human Services ("HHS"). For self-funded and self-administered plans, a plan administrator or plan fiduciary is required to collect and report this information to HHS.

The Act authorizes HHS to determine the information to be reported and the form and manner (including frequency) of such reporting. Entities that fail to comply with the reporting requirements will be fined $1,000 for each day of noncompliance for each individual for which the information should have been submitted. This fine is in addition to other penalties prescribed by law and in addition to any MSP claims with respect to an individual. The Act requires HHS to share the information reported as is necessary for the proper coordination of benefits, and further authorizes HHS to share Medicare Part A entitlement and Part B enrollment information with insurers, TPAs and other entities.

This new reporting requirement is likely to directly affect TPAs, because many self-funded health plans will look to a TPA to provide the reports.  However, it is difficult for TPAs to begin preparing for this new requirement because HHS has not yet issued regulations describing what data to collect and how to report the data.

Submitted by John Barlament, an employee benefits attorney with the law firm Michael Best & Friedrich LLP.  John can be reached at JLBarlament@michaelbest.com or 414.225.2793.  

The contents of this document are not deemed to be legal advice. Specific facts and circumstances should be reviewed and analyzed by your in-house legal counsel, as well as any individual self-funded welfare benefit plan and its legal counsel, in light of specific facts, circumstances, SPDs, subrogation, reimbursement and/or set-off provisions and specific state and federal laws and regulations.

 HCAA Supports SIIA's
 Legal Defense Initiative

HCAA is pleased to announce it has made a $10,000 contribution to The Self-Insurance Institute of America, Inc. (SIIA) to support its legal defense fund. This contribution represents a show of support for SIIA's continued efforts to protect the self-insurance industry from multiple legislative/regulatory threats.

"We know SIIA has been very effective in past legal challenges of importance to our members and are confident that they will continue to aggressively represent the interests of TPAs and others involved with self-insured health plans," said HCAA President Linda Ludwick.

There are currently multiple threats to self-insurance at both the federal and state level, mostly dealing with ERISA, which could prompt litigation in the months and/or years ahead.

"SIIA greatly appreciates this demonstration of support," said association Chief Operating Officer Mike Ferguson. "We fully expect to continue playing a leadership role in defending our industry."

HCAA's membership includes third party administrators, managing general underwriters, insurance carriers, physician and hospital organizations, health care consultants and other industry service providers.

Contributions to SIIA's Legal Defense Fund can be processed on-line at www.siia.org, or by calling 800/851-7789.

 Self-Insurance Institute of America, Inc.
 Issue Backgrounder
 State/Local Reform Efforts Impacting ERISA

Enacted

Massachusetts:

Massachusetts enacted in 2006 a law requiring all residents to have health insurance.  It does this via an individual and employer mandate, funded in part by employer subsidies.  Under the law, employers with 11 or more employees are required to provide health insurance coverage or pay a "fair share" contribution to the state of up to $295 annually per employee.  Employers are also required to offer a Sec. 125 "cafeteria plan" that permits workers to purchase health care with pre-tax dollars.  


Vermont:

Vermont in 2005 enacted a law creating a State health insurance purchasing pool.  Included were subsidies for low-income residents.  Under the law, employers must offer and contribute to insurance for Full Time Equivalents or pay an Employer Health Care Premium Contribution to the State.  The contribution is equal to one dollar per-day, per-total number of full-time equivalents to whom the employers does not offer health insurance.  


Pending

California:

Health reform legislation has been proposed in California by Governor Schwarzenegger, with counter proposals from the State legislature involving employer mandates.  The Governor originally proposed an individual mandate and a "fair share" plan that would pay for a state insurance pool and subsidies for low-income residents.  Employers would be required to pay up to 6.5 % of their payroll on health coverage, or be forced to contribute the equivalent amount to the state.  Various forms of the legislation have been introduced, passed and vetoed.  To date, the Governor and the House Speaker have compromised, but that package has yet to pass the State Senate.  If passed, the package would still have to pass a ballot initiative to fund the plan.  

SIIA is an active participant in an employer-based coalition opposing a proposal that contains an employer mandate. 

Maryland:

Legislation has been proposed to authorize state regulation over excess stop-loss insurance lines.  The legislation would restrict the number of carriers by implementing a certification process.  Maryland has already enacted legislation setting minimum aggregate limits and attachment points.  

SIIA has testified twice at the Maryland House of Delegates in opposition to this legislation as well as submitted formal detailed written opposition.  

Ohio:

A proposal is moving in Ohio that seeks to dictate contracting provisions between health plans and providers.  Those requirements affect how networks of health care providers are established and utilized, the participation of health care providers in certain insurance products, the amendment and termination of such contracts and the resolution of contract disputes.  The proposal in its current form would apply to self-insured plans and TPA's of those plans.  The legislation has already passed the State House and is expected to be considered in the State Senate in the near future.

SIIA submitted formal written opposition to the proposals as well as submitted language, agreed upon by the opposition employer coalition that SIIA is a part of, to exclude self-insured plans from the proposals provisions.  

Pennsylvania:

Governor Rendell had proposed legislation that included a "pay or play" mandate.  The proposal includes an individual mandate and seeks to set up a state insurance purchasing pool.  The Governor's original proposal contained a 3% payroll tax for failure to offer qualifying healthcare.  The Governor recently amended his proposal by removing the employer mandate and replacing it with a proposed increase on the State's cigarette tax.  

San Francisco:

A city health plan, Healthy San Francisco, was passed (but overturned by the 4th Circuit Court) that would impose an employer spending requirement.  The "pay or play" mandate would pay for the city run health care centers and included a requirement for employers to contribute per hour minimum for health insurance for all employees working 90 days & over ten hours a week.  A penalty of 150% of amount owed for failure to make contribution.  A stay has been issued by the 9th Circuit Court of Appeals and their official ruling is not expected until mid-year.

 SPBA's Fred Hunt Sends an Open
 Letter to PNC Stating Health Care
 Industry Study is Misleading

Reprinted with permission from: Frederick D. Hunt, President, Society of Professional Benefit Administrators

November 14, 2007

Paula Fryland
Executive Vice President & Manager National Health Care Group
PNC Financial Services Group
One PNC Plaza
249 Fifth Avenue
Pittsburgh, PA 15222-2707

Dear Ms. Fryland:

I was saddened to read PNC's superficial White Paper on reducing health care administrative costs. SPBA and I have a very long record of being allies in your goal, and have worked at the nitty-gritty level towards that goal for a third of a century. So, this letter is not disagreeing with PNC's goal. I¹m merely saying that PNC's report was naïve.

I should mention that an advantage of having been personally involved in this work for so long is that I can spot retreads. Your report is a retread of the same breathless alarm and suggesting easy solutions done by the first Bush Administration¹s Department of Health & Human Services. I was on that high level panel, and watched as the government & industry officials realized that they had been thinking of the fluff, not the real issues.

For example, by far the largest reason for tedious administration and costs is Federal & State governments. However, your report says nothing about that. Thus, your report would be like me saying that Americans could triple their commuting gas mileage if they just zoomed through town non-stop. Of course, you would say that such an idea is ludicrous because there are speed laws, and stoplights, and one-way rules etc. You would be correct, and that is what I am saying about your report.
It talks about zooming along without any mention of the existence or compliance with the very complex web of thousands of laws & rules & regulations that are in place.

Laws & Regulations Covering Health Care Benefits are Plentiful

Every year, there are hundreds of new laws, regulations, interpretations, opinions and court cases applying to the administration of health care & benefits. Just one example I heard on the news this morning is of the mega millions of dollars of administrative costs for medical facilities (and the same level of administrative costs for heath payers) for the HIPAA privacy law. HIPAA Privacy is just one law out of the couple thousand administrative laws & costs of government compliance. Ironically, lawyers have been so good at spooking medical entities about HIPAA privacy, that it has become one of the main reasons for hesitation to move towards administrative simplifications such as automation of billing, payments, and patient records which your report is promoting. So, in this example, is PNC suggesting repeal of the HIPAA privacy law?

I talk to dozens of technology entities every year seeking to implement what your report suggests. They prefer to brush off or over-simplify obeying the applicable laws. However, it is not something that can be programmed. I used to tease my friends at the Department of Labor (the largest regulator of health plans in the US) that their answer to every technical compliance questions was, "It depends on facts & circumstances." I now find myself using that answer all the time, because it is the truth. There are so many variables at each step of any situation.

Adding insult to injury, getting official direction how to obey the many laws is evolutionary. Only about 1% of the applicable laws have full complete final guidance. In fact, one of the problems we have is that lawyers and others eager to be "efficient" jump to their own conclusions and assumptions of the intent of the law. I understand that urge, but the ultimate goal is not speed, but keeping the patient and/or paying entity such as an employer out of jail. (Yes, some seemingly innocent goofs can send you to jail.)

Also, a challenge for technology zooming through health administration is that some laws require that things that do not exist and have no reason to be known by the administration system must be dealt with.  

For example, if a worker is on Medicare or has a spouse on Medicare, then the employer plan pays primary.  However, what if the doctor or hospital just bills Medicare or bills both, or the doctor bills the private plan, but the hospital does not (and the variations of possible goofs go on and on)?

Medicare holds the payer responsible for the bills it never knew about or never received or which Medicare accidentally paid in duplicate. I'd love to see the software that flawlessly zooms through that kind of situation. Medicare has the power to come back and demand full payment for any "erroneous" payments (including those never known or those that Medicare paid in error in duplicate) up to 6 years after Medicare discovers the "error".

Meanwhile states already have about 1,900 mandated benefits, and states are quickly rushing into new health concepts which seem to bring a heavy dose of administrative cost, if not in the payment process, administrative headaches will emerge in determining what individuals or employers will have to do to obey the laws to qualify for or comply with the 50+ different laws.

Medical Fraud, Waste, Abuse and Real Prices

Your report and the technology concept also ignores the second biggest reason for administrative costs: medical fraud waste and abuse by both medical provider entities and fraud waste & abuse by patients. It reminds me of the very expensive missile race during the cold war or the increasing time & checks at airport security. Doctors or patients find a way to game the payment system or cheat. Payers then impose an administrative procedure to catch that scheme. Then, another scheme or fad arises, and another administrative process is imposed to catch that cheating. It goes on and on and on. Frankly the cheating schemes are so clever and complex that it takes a human eye to be most accurate (and ERISA fiduciary duty law requires accuracy). One of the great fears (by some who have been dealing in EDI is that technology doesn't catch errors.

Interestingly, a large part of the administrative cost these days for both medical entities and payers is the various arrangements to figure out what is the proper cost for a medical service. A survey in California quoted in the Wall Street Journal showed as much as a 1,000% range of costs for the same procedure in the same medical facility by the same doctor. Phony pricing has become a terrible scandal and originates as ways that medical providers tried to work around the steep discounts Medicare demands. Again, processing a claim is easy; it is taking the time to research the best price. Otherwise, you're saving administrative costs but ballooning the medical costs.

"So what?", you might say, "It's saving administrative money." The reason is that with the phenomenal costs of health services today, "accidental" miss-billings (which are almost always suspiciously in favor of the medical entity doing the billing) and charges for operations and services that never happened far outweigh administrative costs to prevent the overcharges.

Self-Funded Health Plans Are Majority Payor Over Insurance Companies

"Insurance companies" are the popular whipping boy (SPBA does not represent the insurance industry), but your report did not seem to mention the largest payer of employee health care & administrative costs: employers using self-funding.

Believe me, employers and plan participants (patients) have always been adamant about being as frugal as possible, because they see and feel every penny. Similarly, Consumer Directed Health Plans (CDHP), such as HRAs & HSAs, and that market is also directly interested in cost-efficiency in administration. (In fact, an early problem was that some banks charged outrageous fees for their administrative role in HSAs.) So, it is not as if the largest segment of the payer community has not always had intense vested interest in having cost efficient administrative services.

In fact, it is that desire for cost-effective administrative services that is the reason for SPBA. We are the national association of Third Party Administrators (TPAs) who are hired mainly by self-funded plans to make the WHOLE true process (administration, government compliance, & proper level of payment) as cost efficient as possible, The role of the TPA is somewhat like the hiring of a tax-preparation firm for the most efficient & legal processing for taxpayers. Visit our website at http://users.erols.com/spba for an understanding of the types of laws & situations which impact administration in the real (law-abiding) world. When TPAs are hired, their administrative fees are very plainly visible & negotiated (and even subject to review by the Department of Labor in most cases to be sure that they are "prudent").

As your report alludes, insurance companies & HMO administrative costs are invisibly buried in the total premium.

Warning of Misleading Statistics

Let me end with a warning to be aware of misleading statistics.

For example, in earlier studies of administrative costs, and using Medicare and VA as examples, I believe Medicare said that their total administrative cost was 3%. That sounds great and got much ballyhoo. However, it turns out that the 3% was only what they paid contractors; it did not include any of the gigantic overhead of CMS staff, offices, etc. etc. I warn people that every number or statistic in health, benefits, insurance, etc. has a built-in 1,000% distortion factor. It is not that anyone is trying to lie.

It is merely that even the most basic vocabulary terms (such as what was included as "administration costs" in the Medicare example above) have vastly different meanings among payers, and medical providers. So, be very careful not to quote (and certainly don't add, subtract or multiply) statistics.

Also what you are probably counting as "administration" costs includes a fast-growing selection of ancillary services. For example, a wide assortment of wellness and other services to help patients and the system better are now provided by payers and included in "administrative" costs.

So, you can see why the PNC report seems superficial and naïve to a person who has been in the real-world trenches of this issue for over 30 years. At the start, I mentioned that PNC¹s report is deja-vu of the high priority on this topic by the first Bush Administration.

What was their outcome? After starting from the same premise as you, that technology would solve problems and save money, the Federal government discovered that the biggest cause of administrative cost in health is the Federal & State governments. They also realized that there is as much attention & effort for cost-efficient health payment administration as the laws and the comfort level of the users allow.

I hope that PNC will do a further study that voices these real-world realities instead of the previous approach. Remember in all your studies: Processing a bill and sending money is easy. TRUE administration is being sure that it is the right patient for the right service for the right amount, and complies with a few thousand laws & rules.

Sincerely,

Frederick D. Hunt, Jr.
President
Society of Professional Benefit Administrators (SPBA)
Fred@spbatpa.com

 Health Insurance in the Spotlight,
 but what about Efficiency?

By Ron E. Peck, Esq.

A casual observer will tell you that healthcare in the United States is a hot topic.  During this election year, every candidate has a plan to "fix" the broken healthcare system, and provide healthcare for every American.  The problem?  The candidates utterly fail to address one of the real problems with healthcare: inefficiency.  Health insurance carriers are blamed for the soaring costs of healthcare, yet some of the most unnecessary expenses carriers face today relate to the costs of mistakes.  Often, another policy besides the health insurance is liable.  Unfortunately, it is extremely difficult to compel workers' compensation to cooperate, and very few Americans understand how medical payments coverage works, let alone how to file a medical claim with their own auto insurance or homeowner's policy.  When others fail to coordinate benefits, it costs everyone.  As a result, some claims adjusters are too hesitant to pay claims that are the health insurance carrier's responsibility, resulting in expensive and time consuming appeals.  Inefficiency is one of the greatest costs the healthcare industry faces today, and yet it is hardly ever mentioned.

Nobody wants to see the health insurance goliath pass the buck and shift blame to witless providers and injured plan members.  Rather, the media portrays health insurance greed as the sole cause of skyrocketing costs.  Just when our focus as an industry should be on reducing costs of healthcare by enforcing coordination of benefits, the populace has made health insurance subrogation public enemy number one.  For example, the Wall Street Journal featured the tale of a woman, left permanently brain-damaged after colliding with a truck, whose medical expenses were paid for by her employer's plan.  After her family received a settlement, the employer laid claim to the money.  Courts of federal jurisdiction found in favor of the plan.  Courts of public opinion, however, were swayed in the opposite direction.  

What long term effects will absolute enforcement of subrogation terms have?  If legislators are convinced that their constituency stands against health plan subrogation, what new laws will they pass to eliminate the right to subrogate?  Following last August's bridge collapse in Minnesota, state lawmakers are desperately trying to hinder the ability of insurers to reclaim dollars spent, working on a way to prohibit insurance subrogation efforts from tapping into relief funds.   The politicians hope that health plans will yield to political pressure and realize the negative publicity they would face if they attempt to recover funds from bridge victims.  

To date, health insurance carriers have chosen to "hang their hats" on legal precedent.  What they don't understand is how tenuous such precedent is.  For instance, the Supreme Court which held that if a plan reserves a discretionary right, courts will question administrator decisions only if there is no reasonable basis for that decision, Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), has recently succumb to public pressure, becoming stricter in their analysis of plan terms, Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355 (June 20, 2002).  
 
With alarming frequency, legislators are passing bills to counter subrogation.  Courts are finding reasons to question plan denials, and interpret plan terms for themselves.  Health insurance carriers are losing the right to administer their plans and coordinate benefits with other parties.  Yet, these very rights are necessary for the efficient administration of health insurance and reducing the cost of healthcare.  To find a balance and prevent further prohibitive legislation from being passed, we as an industry need to do a better job of teaching the population why coordination of benefits and subrogation are necessary for the efficient administration of healthcare, and do a better job of efficiently enforcing those provisions.

Ron E. Peck, Esquire is an attorney at the The Phia Group LLC., a claims recovery subrogation company, based in Braintree, MA. Mr. Peck can be contacted at ron.peck@phiagroup.com or 781-535-5678.

The contents of this document are not deemed to be legal advice. Specific facts and circumstances should be reviewed and analyzed by your in-house legal counsel, as well as any individual self-funded welfare benefit plan and its legal counsel, in light of specific facts, circumstances, SPDs, subrogation, reimbursement and/or set-off provisions and specific state and federal laws and regulations.

NewsByte

The Phia Group, LLC, announced a new strategic alliance with Recovery Data Connect, LLC.  As part of the relationship, The Phia Group will utilize Recovery Data Connect's national litigation database to uncover cases enabling The Phia Group to identify unique subrogation opportunities and increase recoveries for its customers.  The service is offered at no additional cost to The Phia Group's clients.

Premier Healthcare Exchange (PHX) announced that it has chosen ViPS® STARSentinel, an automated, early-warning fraud detection application, to enhance the results of XPERT Connect its renowned cost containment platform.

The Sentinel Group, a leader in healthcare anti-fraud and abuse services, saved its clients close to $10 million in 2007 by avoiding payment of potentially fraudulent and abusive health claims.

Advanced Medical Pricing Solutions (AMPS) and The Phia Group, LLC announced a strategic alliance of their organizations, increasing the value of services provided by both organizations. By combining AMPS' medical bill review (MBR) services with The Phia Group's insurance claim recovery and subrogation services, the value of both AMPS cost containment solutions and The Phia Group's claim recovery services is increased.

 

 Welcome New Members!

Premier Healthcare Exchange
John Powers, Chief Marketing Office/Director of Anti Fraud Services
60 Morris Turnpike, 3rd Floor
Summit, NJ 07901
PH:  630.836.8611
FX:   973.218.9224
jpowers@phx-online.com
Type:  Other-Medical Claims Cost Containment

Maxor National Pharmacy Services Corp.
Sawyer Clark, Senior Marketing Specialist
320 South Polk Street, Suite 100
Amarillo, TX 79101
PH:  806.324.5565
FX:   806.324.5495
sclark@maxor.com
Type:  PBM

NorthWind, LLC
Douglas Thomas, President
1595 Paoli Pike, Suite 103
West Chester, PA 19380
PH:  610.840.0401
FX:   610.840.0402
dthomas@northwindllc.com
Type:  MGU

Total Administrative Services Corp.
Ken Odom, VP Sales & Acquisitions
2302 International Lane
Madison, WI 53562
PH:  800.422.4661 X4290
FX:   608.661.9614
Ken.odom@tasconline.com
Type:  TPA

USBenefits Insurance Services, LLC
Marcus Floyd, Executive VP, Marketing
4425 Jamboree Road, Suite 280
Newport Beach, CA 92660
PH:  949.468.3023
FX:   866.504.4872
mf@usbins.net
Type:  MGU

HM Insurance Group
Heidi Whoolery, Director, Regional Sales
2200 Sixth Ave, Suite 526
Seattle, WA 98121-1849
PH:  206.239.9694
FX:   206.239.9695
Heidi.whoolery@hminsurancegroup.com
Type:  CAR

Arrowhead Administrators
Stephanie Oliver, Operations Manager
PO Box 5866
San Bernardino, CA 92412-5866
PH:  909.379.6821
soliver@arrowheadadmin.com
Type:  TPA

ASR Health Benefits
Mary Brandon, VP Operations
3033 Orchard Vista Drive
Grand Rapids, MI 49546
PH:  616.957.1754 X3008
FX:   616.464.6608
maryb@asrcorp.com
Type:  TPA

Healthplace America
Philip Valk, Managing Partner
901 Warrenville Rd
Lisle, IL 60532
PH:  630.963.9639
FX:   630.963.9638
pvalk@gchcare.com
Type:  Other-Specialty Network

Cairnstone
Kathleen English, VP Sales & Marketing
409 Broad Street, #210
Sweickley, PA 15143
PH:  412.741.4878
FX:   412.741.4873
kenglish@cairnstone.com
Type:  CAR

International Specialty Underwriters (ISU)
Tom Thompson, Western Marketing Director
15527 East Acacia Way
Fountain Hills, AZ 85268
PH:   480.882.8840
tthompson@isu-inc.net
Type:  MGU

Health Services Benefit Administrators, Inc.
David Haumesser, President & CFO
160 Airway Blvd.
Livermore, CA 94551
PH:  925.454.4315
FX:   925.443.2035
dhaumesser@hsba.com
Type:  TPA

Medco Health Solutions
Jeff Ramos, VP of Sales
3 Sugarhill Road
Nyack, NY 10960
PH:  845.358.3609
FX:   845.353.2604
Jeffrey_ramos@medco.com
Type:  PBM

Devon Health Services, Inc.
Susan Rosengarten, Executive Assistant
1100 First Ave
King of Prussia, PA 19406
610-757-4157  Tel
610-768-9504  Fax
srosengarten@devonhealth.com
Type:  PPO
 
Insurance Management Services
Patrick Sanders, VP of Marketing
731 North Taylor
Amarillo, TX 79107
806-373-5944  Tel
806-373-3121  Fax
patricks@imsm.net
Type:  TPA
 
AllMed Healthcare Management
Brian Vervynck, VP of Sales
621 SW Alder Street, Ste 740
Portland, OR 97205
425-457-6387  Tel
503-223-6244  Fax
brian@allmedmd.com
Type:  Other-External Peer Review
 
Universal Health Network
Mary Hoover, Vice President
639 Isbell road, Suite 400
Reno, NV 89509
775-356-1159  Tel
775-352-8207  Fax
mary.hoover@uhsinc.com
Type:  PPO
 
Global Claim Resources
Justin Timmons, Senior Project Manager
8040 East Morgan Trail Rd, Ste 18
Scottsdale, AZ 85258
866-888-4427  Tel
866-999-4427  Fax
jtimmons@gcrinc.com
Type:  Other-Cost Contaiment

HealthFirst TPA
LaRea Albert, COO
PO Box 130217
Tyler, TX 75713
PH:  903-509-5790
FX:  903-509-5723
lalbert@hftpa.com
Type:  TPA

HealthMedia, Inc.
Kevin Howat, VP, Direct Sales
130 South 1st St.
Ann Arbor, MI 48104
PH:  734-623-0000
FX:  734-623-0003
khowat@healthmedia.com
Type:  Other-Behavior Modification

NuFACTOR Specialty Pharmacy Services
Laurel McDonnell, Senior Director
746 West Fig Street
Fallbrook, CA 92028
PH:  951-526-7335
lmcdonnell@nufactor.com
Type:  PBM

Envision Pharmaceutical Services
John Ewell, Exec. VP of Sales & Marketing
2278 Camino Ramon, Suite 4
San Ramon, CA 94583
PH:  805-402-3973
FX:  925-327-0212
jewell@envisionrx.com
Type:  PBM

TC3 Health, Inc.
Cynthia Rodriguez, Marketing Manager
245 Fischer Ave, #D1
Costa Mesa, CA 91626
PH:  714-689-1919
FX:  714-689-1935
crodriguez@tc3health.com
Type:  Other-Loss Control Technologies

Healthx
Jodi Hunter, VP Marketing
9339 Priority Way West Dr., Ste 150
Indianapolis, IN 46240
PH:  317-218-0616
FX:  317-843-4195
jhunter@healthx.com
Type:  Other

Integrity Administrators, Inc.
Brent Jones, President
PO Box 13128
Sacramento, CA 95813
PH:  916-921-3388 X307
FX:  916-921-3383
brentjones@integrityadmin.com
Type:  TPA

INETICO, Inc.
Joseph Hodges, President
PO Box 10972
Tampa, FL 33679
PH:  813-258-2200 X202
FX:  813-514-0607
jhodges@inetico.com   
Type:  Medical Management

A&I Benefit Plan Administrators, Inc.
Julie Zola, Director of Marketing & Business Development
1220 SW Morrison Street, Suite 300
Portland, OR 97229
PH:  503-242-1613
FX:  503-228-0149
Julie.zola@aibpa.com
Type:  TPA

Red Card Systems
Danielle Guempel, Sales & Marketing Coordinator
10812 Ambassador Blvd.
St. Louis, MO 63132
PH:  314-692-8060 X3028
FX:  314-692-8062
dguempel@redcard.com
Type:  Software

First Administrators, Inc.
Tricia Johnson, President/CEO
PO Box 9900
Sioux City, IA 51102
PH:  712-279-8420
FX:  712-279-8450
tricia.johnson@firstadministrators.com
Type:  PBM

 
For information about membership, call 888-637-1605 or email HCAAinfo@HCAA.org

In This Issue

Letter from the President

Record Attendance for 2008 Executive forum

SAVE THE DATE!

New Medicare Secondary Payer Reporting Requirement

HCAA Supports SIIA's Legal Defense Initiative

State/Local Reform Efforts Impacting ERISA

SPBA's Fred Hunt Sends an Open Letter to PNC

Health Insurance in the Spotlight, but what about Efficiency?

NewsByte

Welcome New Members!

HCAA Members

Acclamation Systems, Inc.

Advantek Benefit Administrators 

AIG/Medical Excess 

 Allegiance Benefit Plan Management, Inc.

AllMed Healthcare Management

 AmeriBen/IEC Group

 American Health Holding, Inc.

 Arizona Foundation for Medical Care 

Arrowhead Administrators

ASR Health Benefits

Benefit Informatics, Inc. 

 Benefit Management Administrators 

 Ben-E-Lect 

 BEST RE, Inc.

Cairnstone Inc.

Calypso Healthcare Solutions 

 Capitol Administrators 

 CBA Administrators
 
 CDS Group Health 

 Coastal TPA, Inc. 

 Community Health Group 

 Coresource, Inc. 

 Corphealth, Inc. 

 Delta Health Systems 

 Dentafits-RxReins

Devon Health Services

 EBA&M 

 Ecom PPO Advisors, Inc. 

 Employee Benefit Management Services, Inc. 

 EnCore System Professionals

Envision Pharmaceutical Services

Express Scripts, Inc. 

 First Choice Health Network

 First Dental Health

 First Recovery Group

FirsTier GA

 Fnd for Medical Care of Kern County 

 Fnd for Medical Care of Tulare & Kings Counties 

 Foundation Administrative Services, Inc. 

Global Claim Resources

 HBS Insurance Services 

 HCC Life Insurance Company 

 Health Future LLC

Health Services Benefit Administrators, Inc.

 Healthaxis, Inc. 

 HealthCare Direct of Oregon

 HealthCare Solutions Group Inc.  

HealthComp Administrators

HealthFirst TPA

HealthMedia, Inc.

Healthplace America

 HealthRisk Resource Group Inc.

Healthx, Inc.

 Hines and Associates

HM Insurance Group

 Humboldt-Del Norte Fnd. For Medical Care 

 Ingenix 

Insurance Management Services

Integrated Solutions for Benefits

Intergrity Administrators, Inc.

 Interface EAP 

 Intermediary Insurance Services, Inc. 

 Interplan Health Group 

 IOA RE

ISU - International Specialty Underwriters

 Keenan & Associates

Maxor National Pharmacy Services, LLC

Med Cap Insurance Services, LLC

Medco Health Solutions

 Medical Eye Services, Inc. 

 MedImpact HealthCare Systems, Inc. 

 MemberHealth Inc. 

 Michael Best & Friedrich LLP 

 MMSI, Inc. 

 Mountain States Administrative Services 

 Munich Re HealthCare 

 Mutual Assurance Administrators 

 Mutual of Omaha 

NorthWind, LLC

NuFACTOR Specialty Pharmacy Services

OneSource StopLoss Insurance Marketing 

 Orange County Fnd for Medical Care 

 Partners Rx Management LLC 

 PCG Software, Inc. 

 Pequot Health Care 

 Performance Health Technology 

 PharmaCare 

 Pinnacle Claims Management, Inc. 

 Preferred Medical Claim Solutions

Premier Healthcare Exchange

 Professional Benefit Administrators, Inc. 

 Professional Insurance Consultants, Inc. 


 QVI Risk Solutions Inc. 

 R. E. Moulton, Inc. 

Red Card Systems

 RESTAT 

 RMTS, LLC 

 Self-Funding Actuarial Services, Inc.

 Sierra Benefit Solutions Ins. Svcs. Inc. 

 SOCRATES, INC. 

 Southwest Service Administrators, Inc. 

 StarLine Group 

 Summit Administration Services Inc. 

 SunGard, iWORKS GBAS 

 Swiss Re 

 Symetra Life Insurance Company

TC3 Health, Inc.

 The Lungen Group 

The Phia Group, LLC

The Principal Financial Group 

 The Sentinel Group

Total Administrative Services Corp.

 TPAA 

 Tranquilmoney 

 Tri-County Schools Insurance Group 

 TRU Services, LLC 

 U. A. Local #447 Pipe Trades Trust Funds 

 United Administrative Services 

 United Medical Alliance

Universal Health Network

 WellDyne RxWEST 

 William J. Sutton & Co. Ltd. 

 WorldDoc, Inc.