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County hears insurance-plan update after ValueHealth collapse; TPA Edison handling claims
Summary
Gallagher briefed commissioners on the county—mployee health plan transition after ValueHealth folded; Edison was selected as the new third-party administrator and ProvidersCare detailed fixes to network/EDI problems; staff said rebates from the PBM are now passed through to the county.
Commissioners heard an update from Gallagher and network representative ProvidersCare about the county—mployee health plan and recent vendor disruptions.
Jeremy Gilson of Gallagher said ValueHealth folded without notice last year, prompting an RFP that led the county to select Edison as the new third-party administrator; Edison has been working with the county to resolve outstanding claims and will meet employees in a 2:00 session to close lingering issues. "Edison has been a fantastic partner," Gilson said while summarizing the transition and current status.
Mike Moore of ProvidersCare described three related challenges during the year: the ValueHealth collapse, the Change Healthcare data breach and a subsequent EDI vendor change at ProvidersCare. He said ProvidersCare has addressed those issues, moved claims processing in-house, and implemented training and metrics to monitor performance. Commissioners questioned deductible-related problems and collections; the project team said several claim items remain under resolution but that the partnership and processes have markedly improved.
Why it matters: Payroll, benefit continuity and employee access to care were affected during the TPA disruption. Staff told the board they are managing outstanding claims, that Edison and the county—enefit partners are coordinating drop-in meetings for employees, and that prescription-rebate passthroughs now accrue to the county rather than to a single carrier.
Outcome: No formal action requested; staff and vendor representatives will continue to monitor claim resolution and report back as issues are closed.
