
We will create personalized log-on facilities for employers so they may examine non-confidential claims data and check status on claims, request for information and premium payments. Employers can gain detailed information on processed items, pending items and have immediate access to check registers and accounting data. We have designed our system in a database format giving us the ability to access and download information, and create reports which fit the employer's needs.
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Check Registers Explanation of Benefit Payment Forms Letters/Request Items Large Claim Identification Report - Paid, Pending and Reserved Basis Claim Totals by Employee/ Family (High Incidence Report) Length of Stay Report by Expense Code Analysis by Expense Code, CPT-4 Code, Cause of Loss Provider Report - Activity, Trends, Diagnosis Codes Turnaround Report Pending Claims Report Census Report Coordination of Benefit Reports
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To verify the plans are operating at their maximum efficiency, we establish a regular schedule of communication between the Employer, the Agent and our offices. Our purpose is to establish as routine the exchange necessary to manage the plan. The agenda for these discussions is wide ranging and offers the employer and agent the opportunity to discuss both general concepts and performance particulars. Questions will arise during the plan's operation. Employees will comment on particular service items or benefit levels, and the regular discussion of questions, problems and opportunities make the program run more effectively.
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We include all of the required forms to meet the requirements of federal authorities in the operation of your plan. This includes required 5500 forms and 1099 forms - for all interested parties.
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Within our own organization and in cooperation with your selected agent, we perform periodic updates, reviewing both the overall and specific performance of the plan. These discussions provide the basis for improvements in our performance, but also highlight necessary benefit changes or improvements for the employees. Performance reviews of managed care entities---preferred provider organizations, case managers, etc.---occur regularly. Industry wide improvements in the level of, and the delivery of service, require regular reviews. The wide range of programs we administer helps us coordinate a broad variety of services within our organization. As these services become beneficial, it is our responsibility to inform and evaluate how they will affect the plan's operation.
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