- 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.
