Insights from Amy Hartigan, Vice President, Claims, Berkley Accident and Health

In an era of rising health care costs and increasing scrutiny over fiduciary responsibility, Berkley Accident and Health has introduced a forward-thinking solution to help employers safeguard their self-funded health plans. The Payment Integrity endorsement, now included automatically on all new and renewal Stop Loss policies¹ at no additional cost, is designed to encourage policyholders to catch costly billing errors before they impact plan assets.

What is the Payment Integrity Endorsement?

The endorsement provides a financial incentive for policyholders to audit large facility claims before payment. If a covered health care facility bill exceeding $50,000 is audited by an approved third-party firm,² and errors are found, Berkley will reduce the Specific deductible for that claim by 25% of the realized savings, up to $25,000.³ In addition, Berkley will pay for the audit itself, delivering further on our commitment to payment accuracy.

This benefit is rooted in a simple fact: medical billing errors are widespread. Studies have shown error rates ranging from 7% to over 75%, depending on the source.⁴ Whether these errors consist of duplicate charges, upcoding, or misapplied codes, they can significantly inflate costs.

Amy Hartigan
Vice President, Claims

“In today’s environment of rising healthcare costs, auditing large claims isn’t optional — it’s essential. Our Payment Integrity endorsement reflects Berkley Accident and Health’s commitment to ensuring every dollar is spent correctly,” said Amy Hartigan, Vice President of Claims at Berkley Accident and Health. “Accuracy in billing is a fiduciary imperative, and it empowers sponsors to protect their plans while reinforcing trust in the system.”

How It Works

Here’s a quick breakdown of the Payment Integrity process:

• Eligibility: Any covered health care facility charge exceeding $50,000.
• Audit: The audit must be performed by an approved vendor before a claim payment is made. Berkley pays for the audit.²
• Submission: The audit report must be submitted with the claim.
• Deductible Reduction: Berkley calculates savings and reduces the Specific deductible accordingly.

For complete details about Payment Integrity, read more.

Why It Matters to Broker Advisors

For broker advisors, the Payment Integrity endorsement is a valuable conversation starter. It’s a great way to showcase your commitment to transparency, innovation, and fiduciary support.

Here’s how Payment Integrity can help you:

• Highlight fiduciary responsibility: Employers are increasingly expected to manage plan assets prudently. Auditing large claims is a proactive step toward fulfilling that duty.
• Emphasize cost control: Catching billing errors before payment helps reduce unnecessary expenditure and preserve plan assets.
• Showcase leadership: Berkley Accident and Health is among the first to offer this kind of standard benefit. It can help differentiate your agency.

“Bringing Payment Integrity into the conversation positions brokers as strategic advisors—not just product providers. It’s a way to demonstrate foresight and value,” added Amy Hartigan.

Final Thoughts

Payment Integrity is more than a policy feature. It’s another way Berkley Accident and Health is helping to make self-funding more accessible and predictable for employers.

Learn more: Payment Integrity

¹ In approved states
² When done by a third-party auditor approved by Berkley Accident and Health
³ If the Specific deductible for that claim has already been met, a reimbursement of 10% of the savings identified during the audit will be issued to the policyholder.
⁴ JAMA Network, Reported Variation in Hospital Billing Quality, December 18, 2023, https://jamanetwork.com/journals/jama/fullarticle/2813347June 9, 2020; JAMA Network, Frequency and Types of Patient-Reported Errors in Electronic Health Record Ambulatory Care Notes, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766834; and KFF Health News, Studies Find High Rates of Errors in Medical Billing, March 28, 2016, https://kffhealthnews.org/morning-breakout/studies-find-high-rates-of-errors-in-medical-billing/

Coverage is underwritten by Berkley Life and Health Insurance Company and/or StarNet Insurance Company, both member companies of W. R. Berkley Corporation and both rated A+ (Superior) by A.M. Best. Not all products and services may be available in all jurisdictions, and the coverage provided is subject to the actual terms and conditions of the policies issued. Payment of claims under any insurance policy issued shall only be made in full compliance with all United States economic or trade and sanction laws or regulation, including, but not limited to, sanctions, laws and regulations administered and enforced by the U.S. Treasury Department’s Office of Foreign Assets Control (“OFAC”).

BAH AD 2025-221       © Berkley Accident and Health     12/25