MEDICAL CLAIMS ADMINISTRATION


MEDICAL CLAIMS ADMINISTRATION


We provide comprehensive health benefits plan (claims) processing and administration, including medical and reimbursement account claims adjudication, enrolment and eligibility.

All of our claims administration services are conducted on-site by our experienced team, and with our state-of-the-art proprietary claims processing system that utilizes automated checks and balances, to ensure that all claim payments are appropriate.

Services offered include:
▪Call Center Support
▪Dependent Eligibility Audits
▪DRG Bill Audits
▪Benefit Plan Administration Management for Employees
▪Plan Design and Implementation
▪Reporting and Analytics
▪Resolution & Appeals Services

PREMIA helps its clients in reducing administrative and medical costs and improving relationships with network providers, with our comprehensive health benefits plan claims processing and administration, including medical and reimbursement account claims adjudication and payment, enrollment and eligibility services.

When it comes to controlling complexity and cost in claims processing operations, health plans need to move from a retrospective “pay and chase” to prospective prevention; that is why all of our claims administration services are conducted on- site by our experienced team along with our state-of-the-art proprietary claims processing system that utilizes automated checks and balances, to ensure that all claim payments are appropriate.

Electronic Claims

Over 90% of our claims are received through electronic data interchange (EDI). This allows us to automatically adjudicate claims based on the client's specific benefit plan. Our claims examiners review claims as they are adjudicated to pinpoint any potential errors, or address special circumstances requested by each client.

Eligibility and claims information are electronically transmitted, allowing for quick turnaround of payments.

Performance Standards

We strive to exceed our clients' expectations and commit to strict claims processing performance standards. Our claim system is completely flexible; this enables our claim professionals to work with a client’s internal risk management team to learn the intricacies of an organization and develop an administration program that is appropriate and efficient.

Our claims professionals fully investigate and vigorously pursue all claims with potential subrogation. In addition, our quality assurance team closely follows clients’ instructions and implements best practices. PREMIA devotes special resources to specialty claims that are either high amounts or high intensity.

Our Claims Management Administration program focuses on the following key services:
▪Call Center Support
▪Dependent / Eligibility Audits & Enrollment Management
▪DRG Bill Audits
▪Benefit Plan Administration Management for Employees
▪Plan Design and Implementation
▪Reporting and Analytics
▪Resolution & Appeals Services