OUR SERVICES PROVIDER CONNECTIVITY FOR CLAIMS SUBMISSION
- Supports a variety of claim submission options including:
1. Electronic claims submission via our payor identification number
2. Conversion of paper claims to electronic transactions
3. Provider portal of entry of the claim
4. Upload of claims file electronically into the secure portal - Realtime eligibility verification including 277 and 276
- Superior adjudication logic for automatic processing of the claims at the clearing house
FINANCIAL SOLUTIONS
- Reporting for individual and group policies to stop-loss carriers
- Premium and billing reconciliation
- Claims dashboard to measure trends and project future exposure
- Integrations to Multiple PPO Networks
- Expertise in leveraging high performance networks with unique plan designs to drive utilization and contains costs
- Full electronic payment suite of services
1. Provider network that typical results in more than 70% of payments originating via ERA
2. Ability to batch payments and remittance advices to reduce costs
ENROLLMENT & HRIS SOLUTIONS
- Level premium funding programs with options for the employer to participate in the risk
- Preferred stop loss vendors with superior pricing based on the underwriting methodology
- Multiple comprehensive plans within the underwriting engine
- Interfaces tot he following platforms:
1. Payroll vendors for the capture of payroll deductions and eligibility reconciliation
2. Ancillary providers of additional benefits like critical illness and hospital indemnity programs
3. Stoploss and reinsurance carriers
- Generation of invoices for all lines of business
1. Full reconciliation and payment processing
- Pharmacy Benefits Manager
UNIQUES PROGRAMS & UNDERWRITING SOLUTIONS
- Level premium funding programs with options for the employer to participate in the risk
- Preferred stop loss vendors with superior pricing based on the underwriting methodology
- Multiple comprehensive plans within the underwriting engine
1. Leverage Artifical Intelligence to data mine for medical underwriting significantly eliminating the need for health questionnaires
2. Claims experience may not be required as part of the rate development process for employer groups under 150 eligible employees.
