Clarity Benefit Solutions – Claims Harvesting

The Challenge: Clarity Benefit Solutions was substantiating claims manually. When the company shifted its focus from payroll companies to the broker channel, the need for change was immediate to maintain its competitive industry position.

The Solution: Clarity selected TPA Stream as its new claims harvesting and substantiation platform and offered its functionality and benefits to its clients as a free service.

The Result: Clarity has achieved steady growth over the past few years and achieved a 3x ROI in using TPA Stream. Clarity’s brokers can rest assured that employee claims are handled efficiently, and employers and employees are satisfied. Moreover, its broker partners can see firsthand the proper and compliant substantiation of employee claims.

The Challenge

Clarity Benefit Solutions (Clarity) is a third-party benefits administrator providing state-of-the-art technology, products, and services to its broker partners, employer clients, and employee participants. The company was founded in 1990 by current CEO Bill Catuzzi.

Prior to working with TPA Stream, Clarity had not been using a platform for harvesting explanation of benefits (EOBs). To get EOBs in for substantiation, Clarity had to reach out to its clients’ carriers while incurring a file fee that was often charged to Clarity’s client or Clarity itself — creating additional costs and requiring more time to complete. It was an incredibly manual process.

Additionally, for years Clarity had focused almost exclusively on payroll companies as its primary revenue driver. But when the company transitioned its focus off payroll companies a few years ago, it realized it had to build a broker network. However, many brokers already had relationships with third-party administrators. To better compete, Clarity realized it needed to do something different.

But competition wasn’t the only challenge Clarity was facing with brokers. An understanding of IRS guidelines was missing at the broker level. This was due to brokers recommending TPAs to employers with the expectation that TPAs would handle this delicate process. But as Clarity noted, not all TPAs substantiate claims as thoroughly as needed, creating risk and opening the door to even more challenges down the road. With a platform that helped substantiate claims properly, Clarity saw the opportunity to better educate brokers and strengthen their competitive position.

The Solution

Clarity began exploring software solutions on the market — not only to help streamline EOB harvesting and processing but also to differentiate themselves from the competition. Because Clarity positions itself as a technology company, the solution it chose would be integrated into its overall technology offering without imposing any additional cost to its clients — a significant benefit considering that many TPAs charge for these additional services.

“We were looking for more than a provider — we were looking for a partner, and we found that partner in TPA Stream,” said Clarity CEO Bill Catuzzi. “I was impressed with their attitude, philosophy, and entrepreneurship. It was very easy to get started with them. They were very responsive to us.”

With TPA Stream, Clarity can now more efficiently collect EOBs for processing, review, and substantiation. Clarity and its clients no longer need to pay additional fees for accessing this information from carriers as a part of doing business, and the overall time needed to process claims has been reduced. The benefits extend well beyond day-to-day benefits administration, however.

“TPA Stream has become part of our technology sales pitch,” Catuzzi said. “In fact, I recently spoke at a conference about TPA Stream, and we had a ton of broker engagement afterward. The idea of an employee going to a doctor, and that EOB coming into our portal so we can substantiate it without any involvement from the employee apart from signing up — brokers love that. Brokers need to be able to recommend a TPA and move forward confidently, and TPA Stream allows that to happen.”

TPA Stream has also enabled Clarity to better demonstrate the importance of substantiating claims according to IRS guidelines.

“There are TPAs out there that aren’t doing substantiation correctly,” Catuzzi said. “Using TPA Stream, we can help brokers understand that it needs to be done a certain way, how it can be done, and how it can be done compliantly. The bottom line is that we need to know what those card swipes are for, and if we can’t provide that, it’s not a valid claim. Getting that EOB and substantiating it properly is a huge advantage not only for us but also for those we work with. With TPA Stream, we can do this automatically now, and being able to show that to brokers has been a big benefit.”

The Result

In addition to realizing a 3x ROI from its partnership with Clarity, TPA Stream has become a strategic complement to Clarity’s already extensive technology-focused products and services, enabling the company to not only streamline its benefits administration work but also to provide critical education to its broker network while enhancing its competitive position in the market. The latter, in particular, has been working quite well.

“Clarity has been growing by 40 percent over the past three years,” Catuzzi said. “TPA Stream has definitely been part of that growth. We now lead with TPA Stream, and our brokers like it. Throughout our relationship, TPA Stream has been incredibly flexible. They’re good at making changes whenever we request them and have been very responsive. When information comes to me about a vendor, it’s usually because the vendor isn’t doing something right. I never hear that with TPA Stream. They have a good group of people there.”

Clarity now also obtains around 80 percent of its business through the broker channel, with the remaining 20 percent coming from payroll companies. Thanks to TPA Stream, those brokers are now better positioned to champion open enrollment with employers thanks to the automation, efficiency, and service that comes with using TPA Stream. And because the service is provided to employers at no charge, Clarity has become a competitive, strategic sales offering for the brokers with which it partners — helping them to create more relationships and serve more employees.

The Future

Clarity is now focusing on new financial wellness products, with a particular focus on student loans. The company is currently building a product that allows companies to assist their employees with paying down student loans over the first couple years of their employment.

“By 2021, Millennials are going to be the dominant workforce, and about 65 percent have student loans,” Catuzzi said. “With that debt, life decisions are greatly affected. Twenty percent of Millennials are more likely to take a job that helps pay down their debt. By offering this program, employers not only contribute to their employees’ well-being and satisfaction, but they also increase employee retention. The savings that can be realized from that are worth the upfront cost.”

Clarity will be working closely with TPA Stream on this important initiative via its HR and payroll integration. This functionality will help streamline many of the tasks associated with helping employers and employees at participating companies pay down student loan debt.

Why TPA Stream

TPA Stream is a thriving, innovative insurance technology company committed to empowering better healthcare outcomes for employers and their employees.

Learn more about TPA Stream here.

Let's Connect