Health Plan Administration
From receipt to eligibility to negotiation and payment, we handle the entire claims administration process. Completely centralized, all claims, medical management, PPO network management, and billing is managed in-house, allowing us to provide you with flexible and quick service with a personal touch.
What’s more, we recruit and retain claims professionals with the highest level of technical knowledge within the insurance industry. In fact, our adjusting staff has an average of 15+ years of claims handling experience.
Our claims examiners have instant access to each claim received, allowing a high-speed turnaround that averages six days. With an internal auditing department, we have strict quality control practices in place to ensure your claims are paid properly the first time.
Claims Processing Highlights:
- Proprietary system
- Medical, dental, vision, prescription and short-term disability plans
- Unlimited plan design options & Tiered Benefit Structures
- Client Customized Explanations of Benefits (EOB)
- Electronic claims submission capabilities
- Systematic fraud detection
- Integrated claims editing
- Claim Adjustments & Recovery
- COBRA Administration Module
- Stop Loss Module fully integrated with claims
- Section 125 & Disability Modules
- Document Management Integration
- APC Pricing & DRG Grouping
- Enrollment/Disenrollment Services
- 1099 Processing
- Much more ...
Claims Processing Representatives
- Experienced representatives assigned to each client
- Direct telephone and e-mail access
- Ownership of participant satisfaction
- Thorough claims investigation and resolution