Health Plan Administration

Streamline your health plan administrative responsibilities with third-party claims processing, pharmacy administration, consumer-directed health plan options and more. The integrated suite of Mayo Clinic Health Solutions products and services can be combined to create a custom solution to meet your specific needs. Our comprehensive clinical risk management services, including exceptional healthy living and care management programs, make us the benefits administrator of choice for a growing number of employers nationwide.

Claims Administration

For more than 25 years, we have provided expertise in claims administration, including adjudication and payment, enrollment, eligibility, and subrogation services. Experienced claims examiners, an advanced claims adjudication system, the number of electronic claims and a nearly paperless process for non-electronic claims assure timely, accurate and cost-effective processing. Regular audits confirm the security of our systems and internal quality control.

Community Health Collaborative

The Community Health Collaborative combines claims administration services for health systems with enhanced medical management services to provide a regional-based program for local, self-insured employers. This creates new value to providers by highlighting clinical services, comprehensive analytics and service steerage, and to employers through improved member care, better risk management, lower health care costs and reduced trend. With this program, providers deliver superior local care combined with the national reach of Mayo Clinic to meet the needs of members in a given market.

Pharmacy Benefits Administration

We deliver convenient, cost-effective access to prescription medications through a nationwide network of nearly 65,000 pharmacies offering point-of-sale electronic claims processing and mail service provided by the Mayo Clinic Pharmacy. Benefit management is based on the Mayo Clinic Formulary, and our consulting team of pharmacists, pharmacy technicians and medical directors has a proven track record of client savings.

Consumer-Directed Health Plans

To help you manage the factors that drive up your health care costs, our consumer-directed health plan model educates employees about the true costs of health care and involves them in the decision-making process. Mayo Clinic benefit experts and clinical staff work with you to develop short- and long-term strategies for cost containment using Health Spending Accounts (HSAs), Health Reimbursement Arrangements (HRAs) or Flexible Spending Accounts (FSAs).

Integrated Case Management

Our health services experts assist you in protecting your people and curbing the potential impact of avoidable high-cost claims. We provide expertise in disease management, case management, utilization management, transition management, decision support and wellness. Mayo Clinic health services specialists use sound clinical judgment to determine the most appropriate care and cost-effective outcomes for individuals and organizations.

Health Care Financial Consulting

An experienced account management team helps you optimize your program, from planning and preparation to successful implementation. Our consultative service also encompasses engagement and participation strategies, from innovative incentives to promotion and communication tools. We work with you to review and interpret data from reports. This level of support — implementation, integration, analysis — is what transforms best-in-class service into measurable results.

Contact Us

Let’s improve the health of your organization – and your bottom line. Contact us via email or call us!