Dear Members:
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.
