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.

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.

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.

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.

Online portal & Mobile App

Our online portal and 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 AmeriBen 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 only 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

Included in our member website and portal, is an embedded transparency tool that steers members to high quality providers best matched to each person. Search results factor in cost, quality, efficiency, proximity, plan design, member preferences, and the individual’s personal health profile.

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

Machine Readable Files contain information required by federal regulations and apply to certain types of health plans or issuers. These files, often called “MRFs,” are updated monthly and formatted in accordance with federal standards. MRFs are intended to promote transparency, and are one of several different types places to obtain information on costs.

Click here to learn more and see locations where some files can be found

In some instances, AmeriBen is required to display information on a publicly accessible website in order to comply with federal and/or state mandates. This page functions as a repository, if the information is not posted elsewhere.

BSMH Network Exception Waiver
Georgia Aggregate Statistics