County briefs employees on TPA switch; Gallagher says Edison has handled backlog

At a Nov. 11 meeting, Jeremy Gilson of Gallagher and Mike Moore of ProvidersCare updated the Coffey County Commission on the county—mployee health plan after a turbulent year for the prior TPA.

Gilson said the county moved its TPA work to Edison after the ValueHealth disruption and described Edison as "a fantastic partner" in getting outstanding claims processed; he said Gallagher vetted Edison through an RFP and that Edison has been working to clear hanging claims. Mike Moore, who represents the provider network ProvidersCare, said the county experienced issues tied to a data/EDI vendor transition but has largely addressed those problems and has brought claims-processing work back in-house to improve responsiveness.

Commissioners pressed for certainty on outstanding claims, pharmacy deductibles and how prescription rebates are handled. Gilson said the county now carves out the pharmaceutical benefit manager (PBM) and receives rebates as a 100% pass-through to the county rather than those funds being retained by a carrier. He told the board that the "rebates are coming back to the county" and that the county's claim reserve benefits from that change.

The firms said Edison will send a claims representative (Joe) to meet county employees at a 2 p.m. session to help finalize remaining issues, and the county's office staff offered to field employee calls as a local contact point.

The commission did not take formal action on benefits at the meeting but accepted the update and asked staff to continue monitoring claims trends and stop-loss renewal strategies.