At AmeriBen we believe in a strong partnership with our clients.
As your trusted partner, we continually strive to provide the most beneficial services, solutions, and capabilities to our clients are better able to offer valuable benefits at a competitive price.

Financial Controls

We believe in promoting cutting-edge services to every client. We do this through innovative claims processes; a team of quality-focused Customer Care Representatives; and transparent strategic, partnerships with external vendors.

Claims Processing Innovations

AmeriBen is continuously looking for efficiencies and ways to control and manage medical trend, while steadfastly providing accuracy, customer service and timely turnaround.

Through powerful claims edits, 365 day external audit, domestic only claims processing and our focus on the proper adjudication of larger dollar claims, we have achieved remarkable financial results for our clients while also taking great care of their members.

In addition, each client has a designated claims processor. This individual becomes familiar with the intimate details of the plan, taking pride in ensuring claims are processed accurately and timely.

Edits, Reviews, and Audits

AmeriBen's claim edits and clinical bill review partners update regularly to the most sophisticated extraction methods to save an average of 5 to 7 percent of annual medical costs.

All claims processors are subject to extensive and thorough audits daily by AmeriBen's internal audit department as well as a third party audit vendor to ensure our best-in-class accuracy. Any claim exceeding $10,000 is reviewed prior to payment being released. Claims exceeding $50,000 are subject to additional reviews, both internally and by an external auditor.

Service Innovations

Our Customer Care Representatives are 100% focused on call quality and are not incentivized by average call duration or number of calls taken. Our representatives routinely make outbound calls as well, with over one-third of our calls resulting in an outbound conference call with external vendors to solve a problem for a member.

We have found that these three-way calls increase the number of first-call resolutions which not only leaves the member increasingly satisfied, but also our member's providers. Our Customer Care Representatives' only concern is helping the member on the other end of the line.

Pharmacy Benefit Managers

AmeriBen has partnered with several top-ranked, nationally-recognized prescription benefit managers (PBMs). We interface with these PBMs on a daily basis by sending eligibility and accumulators for HSA/HRA purposes electronically. AmeriBen's PBM department has access to dedicated Account Managers and Client Service Teams with these PBMs for quick issue resolution, in addition to recommendations on plan design.

Reference-Based Pricing

Many of AmeriBen's clients currently offer plans with some sort of reference-based pricing integrated into the plan design, most commonly for out-of-network claims. The vast majority of these clients leverage Medicare as the reference base. Our clients have experienced very little member disruption along with exceptional savings when it is implemented with recommended plan language and adequate options for members seeking routine care and local services.

 

Medical Management

Pre-cert

Our in-house pre-certification and concurrent review use nationally recognized medical guidelines to determine the appropriateness of the medical treatment plan, the treatment setting, and the length of stay. Sophisticated computer systems and software programs provide utilization history and allow steerage into network facilities.

Case Management

Working with our certified specialists, all registered nurse case managers can alleviate confusion as well as resolve concerns regarding medical care and coverage. Our case managers maintain direct contact with the patient, the employer, hospital, and ancillary providers.

Stop Loss Interaction

Our nurses and certified case managers use a flexible information management system that supports the collection and management of patient information, and retrieval and tracking of medical case and claims information. This facilitates accuracy and consistency in quality of care coordination, collaboration, communication, and reporting. Within 24 hours of confirming a patient's diagnosis matches a diagnosis on the stop loss carrier's trigger diagnosis list, a large case notification is sent to the client's stop loss carrier.

Health Management

Chronic medical conditions account for the majority of healthcare dollars and lost workdays. Our health management (formerly known as disease management) programs prepare members to actively participate in the management of their chronic medical condition. Due to the high trust levels obtained through our service team, we generally obtain engagement rates 2-3 times the national average.

Wellness

The online wellness program through MyAmeriBen.com includes a wide range of tools and resources to enhance your employees' ability to address health concerns or make lifestyle changes. Some of these tools include:

  • Wellness Assessments

  • Healthy Living Programs

  • Online Seminars

Maternal Health

Our Maternal Health Program provides education, support, and a Maternal Health Nurse who will help keep you and your baby healthy before, during, and after your pregnancy.

Smoking Cessation

Our individualized, one-on-one tobacco cessation program has demonstrated reduction/quitting rates of over 50%.

 

Network Solutions

PPO Network Access

AmeriBen has developed strategic network relationships with several national carriers, as well as national and regional rental networks. These relationships have helped us to provide unprecedented flexibility to large employers who require a national network, but have administrative requirements unfit for a traditional carrier payer.

Additional Claim Discounts

We work with external cost-containment vendors in an effort to provide additional savings to clients through discounts on out-of-network claims. Several of our clients use non-traditional methods on out-of-network claims as well, such as pricing according to Medicare reimbursement models, which is something we can flexibly administer.

 
 

Reporting

Access to Claims Data

AmeriBen's claims adjudication system is fully integrated with our customer care center, PBM (prescription benefit managers) partners, wellness functions, account management functions and medical management. The daily communication between these systems allows for reporting on any aspect of the plan, including prescription benefits and medical spend.

The complete integration of our systems allows us to continuously update our reporting to focus on trend drivers, benchmarking, plan performance measures, and other reporting needs our clients have.

In addition, AmeriBen has a department dedicated to creating reports and analyzing data, thus providing additional resources to meet client needs.

Actionable Results

We provide complete and detailed reporting, identifying trends related to any facet of the plan, including high-cost claims and emergency room visits. Our team then consults with our clients on ways to address problems and identify opportunities specific to their plans. This ultimately allows clients to make informed decisions that are in the best interest of their plans and plan participants.

AmeriBen also provides clinical predictive modeling reporting which allows plans to see, on a risk-adjusted basis, clinical risk drivers of their membership, chronic disease prevalence and gaps in care. We leverage this reporting to consult with our clients on programs and initiatives to improve clinical measures.

 

Consumerism

MyAmeriBen & Mobile App

MyAmeriBen.com and the MyAmeriBen Mobile App provide quick and easy access to claims, benefits and eligibility information 24/7. ID cards can be e-mailed directly to healthcare providers with electronic ID cards. If an answer to your question doesn't appear on our Frequently Asked Questions page, click the "Express Request" button to send an inquiry to our Online Support Specialists. The MyAmeriBen Mobile App even allows users to instantly upload images of relevant claims documents via a smart phone.

All of these features, and more, have been designed to help us achieve our goal of providing convenience, accuracy, excellent customer service, and timely turnaround for all of your benefit needs.

FSA, HSA, HRA

FSA

AmeriBen offers a full Flexible Spending Account administration program that is completely integrated with our medical claims administration system. This allows automatic rollover of claims, simplifying the process for the participants. The integration of systems and administration also shortens the turnaround time for a claim. The claim only needs to be filed once and the system automatically rolls over eligible claims for payment by the FSA plan. Direct deposit capabilities are available.

HSA

An HSA, or health savings account, is a voluntary savings account used to pay deductibles, coinsurance, and other qualified medical expenses (as allowed by the IRS) and can oly be paired with a qualified HDHP. Contributions are pre-tax and your balance accumulates interest. As opposed to an FSA which requires a certain amount to be spent per year or the balance is lost, an HSA allows you to rollover the balance and continue to accumulate interest. Our HRA/HSA partners offer a debit card and 24-hour web access to enable effective management of account balances.

HRA

An HRA, or health reimbursement account, is an account funded by the employer to help pay for certain out-of-pocket medical expenses. Contributions are tax free and not subject to payroll deductions. AmeriBen has options for HRA administration as well, if an employer offers this benefit for their members.

Transparency tools (e.g., HCBB, Castlight)

AmeriBen is a trusted partner with transparency vendors, such as Healthcare Bluebook and Castlight Health. Depending on client size, location, network, and budget, our clients will find a good fit with one of these firms to develop consumerism strategies to drive lower trend and engage their populations to become educated health care consumers. Using these tools, our clients have experienced increased employee engagement in health and wellness programs, reduction in health care costs, and overall improved quality of care for their employees.

 

Eligibility

HRIS Integration

AmeriBen accepts enrollment and eligibility information through Human Resources Information System (HRIS) integration, making the process easier and convenient for benefit plan administrators. We do not require a specific HRIS system, but rather are able to receive electronic eligibility loads from most HRIS systems. We prefer to receive data in the standardized 834 format and files are uploaded into the system within 24-48 hours upon receipt.

Online Enrollment

For clients who do not opt for a private exchange delivery, our web-based enrollment system is designed to allow human resource personnel to directly control their group enrollment information on the claims adjudication system through a simple user interface. Eligibility updates, enrollment changes, terminations and reinstatements may be submitted electronically, eliminating the need for email or other correspondence and simplifying and improving accuracy of claims and service to members.

Consolidated Billing

Whether you opt to have your employees use the private exchange platform or have your human resource personnel provide enrollment information, AmeriBen provides clients with monthly premium billing, which identifies active employees, COBRA participants, and the fixed costs associated with those employees/participants. Vendors' fees are remitted each month based on the information provided, streamlining the billing process.

COBRA Administration

AmeriBen has a first-in-class team who are dedicated to ensuring seamless COBRA administration. Our COBRA Department will:

  • Send COBRA information packets and payment coupons directly to your COBRA participants

  • Receive COBRA payments for deposit to the Plan's bank account

  • Provide monthly monitoring of COBRA eligibility dates and reporting on all participants

  • Ensure that claims will not be paid unless the COBRA participant is active on the plan through our direct customer service COBRA Specialists

 

Contact Us

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MEDICAL CLAIMS & BENEFIT INFORMATION
1-800-786-7930
HUMAN RESOURCE CONSULTING
1-888-432-8811
RETIREMENT BENEFITS ADMINISTRATION
1-888-716-4481
 
Offices In:
BOISE | SALT LAKE CITY | PHOENIX | PLANO