Client Services

  • Toll Free Customer Services with Dedicated Claims Auditor and Dedicated Billing Representative.
  • Supervision & Reconciliation of Employer/Plan Sponsor Checking Account (if applicable).
  • Participant Trust Oversight (if applicable).
  • Monthly Claims Payment Verification via Paper or Website.
  • Auditing and Submitting Claims for Stop-Loss Reimbursement to the Plan.
  • Billing of Fixed Costs Including Stop-Loss Premium, Administrative Fees, PPO Fees, Pharmacy Card, Dental/Vision, and WDI Fees.
  • Record Keeping & Billing of Optional Life, STD, and LTD Benefits (if elected).
  • Maintenance of Group Eligibility to Include Enrollments, Changes and Terminations.
  • HIPAA Notification to Include Verification of Credible Coverage for New Employees & Their Dependents.
  • COBRA Notification to Include Verification of Coverage and Preparation of Participant Monthly Coupon Payment Booklets.
  • Subrogation & Coordination of Accident Claims.
  • Administration of Pharmacy Benefits (with & without Medical Benefits).
  • PPO Integration with Plan Including Provider Discounts, Pre-certification of Claims, Utilization Review, and Large Case Management.
  • Monthly Plan Performance Reports via Paper or Website.
  • On-Going Consulting and Risk Management Services.
  • Website Services for Both Employers and Plan Participants.
  • Preparation of Plan Document, Plan Document Amendments & Employee Plan Benefits Booklets.
  • Federal and State Regulatory Compliance.
  • Plan Compliance with Electronic Data Interchange to Include Protected Health Information & Internet Security Requirements.