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.