Plan Administration

Customizable and Efficient Claims Processing

Claims management is an essential component of a self-funded health insurance program. Claims are handled accurately, promptly and professionally to ensure employee satisfaction.

• On-line Eligibility and Claims History
• Automatic Claim Hold for quality Reviews
• Duplicate Payment Edits
• Specific and Aggregate Reinsurance
• Multiple Plan Options tied to Multiple PPO Contracts
• Benefit plan design and document preparation
• Customizable Reporting Package

Cost Controls

Cost containment is a focal point of our daily operations. The combination of our claims related cost containment programs, medical management and DeanASO Network provide customers with an outstanding overall approach.

Offerings:

• Auto audits to test billing appropriateness
• Bill audit/negotiation for out-of-network/Area physician and facility charges
• Claims review
• Coordination of Benefits (COB) checks
• Duplicate claims checks
• Information close checks (Student status, accident information, other insurance, etc.)
• Non-covered benefit checks
• Pre-existing conditions checks
• Timely filing checks
• Usual and customary charges checks