ELAP Services is retained in a fiduciary capacity by self insured employers to ensure that their plan assets are managed in an ERISA compliant, prudent manner. We measure a provider’s billed charges against allowable claim limits within the plan to achieve these objectives. We make coverage determinations and manage appeals for our clients through final resolution. In addition, we provide legal defense to the member, plan and related parties should any litigation ensue.
ELAP frequently serves as a facilitator of direct contracting between a self funded health plan and a medical provider. We differentiate our services from standard PPO arrangements in several ways:
- We work directly with our employer groups to communicate the benefits of the contracted providers’ services
- We draft plan language to create economic incentives that will induce patients to choose contracted providers
- We advocate on behalf of the providers through our standard marketing channels in each region
- We assign a team of ELAP specialists to the claims processing of these direct contracts to expedite payment to providers
- We ensure that all reimbursements are pegged to a reasonable margin about provider costs
ELAP's role in this changing healthcare landscape is in partnering with health care providers to develop marketing strategies based on direct interface with employers in their communities. The core strengths of ELAP are in the design and operation of the mid-size (100 to 2,000 employees) self insured health plan. These plans are the most flexible vehicles for developing true collaboration between employers and medical providers particularity as it relates to risk sharing and aligned incentives. ELAP can assist a health system or provider organization in building new revenue streams in the self insured market place.