Plan & Claims Administration
Covering Plans from A to Z and Innovating Claims Administration
Our full-service employee benefit consulting and administration services cover a wide breadth of health care plans. Take advantage of our expertise and out-of-box thinking as your lead consultant and administrator for:
- Self-funded and fully-insured medical, dental, and vision plans
- Cafeteria plans
- Consumer-directed plans
- Plan eligibility
- Experience reporting
- Cost containment strategies
We’ll track your claims and provide detailed utilization reports on plans, including specific diagnoses, networks, and providers, such as emergency room use versus urgent care.
Our intelligent claims-paying technology and infrastructure can support multiple plans and provisions, overlapping networks, and diversified geographical and demographical workforces.
We can also help you identify attempted fraudulent claims activity. This provides our clients with the operational awareness of their plan and creates useful reports as a planning tool for future modifications.
In addition to administration and reporting, we support a range of other plan services, including:
- PCORI & Reinsurance Fee Calculations and Payment
- 6055 & 6056 ACA Reporting (1095-C, 1094-C, 1095-B)
- Dependent Eligibility Audits
- Plan Discrimination Testing
- 5500 Reporting and Filing
- Plan Document Review and Creation
- PPO Network Utilization and Savings Analysis
- Pharmacy Utilization and Savings Analysis