CareReview / Who We Serve / Self-Funded Employers
Protect Your Plan and Your People, at the Same Time
Independent clinical review that meets ERISA fiduciary duty and gives you measurable, reportable outcomes on plan spend.
Protect Your Plan and Your People, at the Same Time
Independent clinical review that meets ERISA fiduciary duty and gives you measurable, reportable outcomes on plan spend.
Running a self-funded health plan means you're accountable for how coverage decisions get made — not just for cost, but for whether those decisions hold up if someone challenges them. CareReview gives self-funded employers, and the brokers and consultants who advise them, an independent, accredited partner for prior authorization, appeals, and external review — with plain answers your HR and finance teams need about what's actually happening with plan spend.
The Pressure Self-Funded Plans Are Under
- As a self-funded plan sponsor, you hold ERISA fiduciary duty for how prior authorization, appeals, and external review are handled — that responsibility doesn't go away because a TPA or vendor is involved.
- When appeals are reviewed by the same team that made the original decision, they can look biased — and that's exactly the kind of thing that turns into litigation risk.
- Non-grandfathered self-funded plans are required to provide access to federal external review, and building that capability in-house isn't practical for most employer groups.
- Your finance team wants proof that plan spend controls are actually working, not just activity reports — documented, repeatable ROI matters as much as the reviews themselves.
How CareReview Helps
CareReview reviews are independent: a separate, accredited organization makes the clinical call, so your plan and its members are protected by the same decision. Federal rules require self-insured plans to keep more than one accredited IRO under contract and rotate cases among them. CareReview is built to be the partner you can send anything to — medical and pharmacy, prior authorization through external review, with a fully accredited IRO available nationally that covers your federal external review obligation without another vendor to manage. And because our review workflow runs on Stradix®, our secure platform, you get real, measurable reporting on outcomes — not just a stack of case files.
True Independence
Fully independent clinical review, so your plan and your employees are protected by the same standard.
One Accredited IRO Relationship
One accredited IRO relationship satisfies your federal external review obligation, in every state your plan operates.
Documented, Repeatable ROI
Documented, repeatable outcomes your finance team can use to demonstrate ROI on plan spend, quarter after quarter — not a one-time snapshot.
Plain-Language Rationale
Plain, written rationale behind every determination — built for HR, finance, and legal to understand, not just clinicians.
Related Reading
If a broker or TPA manages your plan day to day, see how CareReview supports Health Plans & TPAs. For a closer look at how coverage decisions actually get made, see our Resources guides on Medical Necessity Review and Prior Authorization Best Practices.