Claims

Clarity at Every Step

Smarter workflows, cleaner data and trusted expertise to simplify the most complex parts of the claims process.

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From enrollment to reimbursement, claims processing can create friction, risk and wasted effort. Lumelight’s Claims team brings structure and strategy to every step—standardizing messy data, streamlining operations and delivering real cost containment. With a flexible model that supports everything from full business process outsourcing to targeted technology innovation, we help clients manage claims with greater clarity and control.

Enrollment Data Transformation
Business Process Outsourcing
Claims Data Analysis
Renal Dialysis Cost Containment
Crossover Claims
Healthcare Claims Audits

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For the Moments That Matter Most

When your compliance challenge is high-stakes, high-visibility or high-complexity, Lumelight One delivers the insight, precision and senior expertise it demands.

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RxDC Frequently Asked Questions

We have RxDC reporting requirements on our minds these days. Specifically, we’ve been worried about our employer friends and how they will handle P2 and D1 filings.
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Hey, Section 1411 Notice, Where Have You Been?

The Affordable Care Act (ACA) has many requirements, and the mandate that health insurance Marketplaces (“Exchanges”) send a notice to employers regarding employees who purchased subsidized coverage through a Marketplace is commonly overlooked. These notices, referred to as “Section 1411 certifications” (because they’re outlined in Section 1411 of the ACA), are part of a process established by the Department of Health and Human Services (HHS) to verify that only eligible individuals receive health insurance subsidies. 
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Follow The Instructions, and Your Gag Clause Attestation Will Turn Out Fine

In May of this year, the Internal Revenue Service and the Departments of Labor and Health and Human Services released updated versions of the Submission Instructions and User Manual for the Gag Clause Prohibition Compliance Attestations (GCPCAs) due by the end of 2024. This update includes several notable changes to the annual submission process for group health plans and issuers offering group or individual health insurance coverage.
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Mental Health Parity, Fiduciary Certifications, and Short-Term Implications

As many of you know, the Department of Labor (DOL) released their much-anticipated Mental Health Parity and Addiction Equity Act (MHPAEA) Final Rules last month. Many of the more significant updates to the requirements don’t take effect until a plan’s renewal on/after January 1, 2026, but a few notable items will begin applying in just a few months, once a plan renews on/after January 1, 2025. These provisions include a new fiduciary certification, a codified termination of the MHPAEA opt-out opportunity for non-Federal governmental plans, and both new and revised definitions for relevant terms.
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New Employer Reporting Regulations Impact ACA Employer Mandate Penalties

In December of 2024, the Employer Reporting Improvement Act was signed into law that gave rise to new processes that ease some of the ACA burdens for employers.
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Executive Order Issued To Make Healthcare Prices More Transparent

In an effort to make sure patients are provided with accurate information concerning prices of their healthcare, the President has issued an Executive Order directing further enforcement of the Executive Order he signed in 2019 (EO 13877).
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