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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 WaiverGeorgia Aggregate Statistics
“Working with AmeriBen’s team is an absolute joy. I find everyone to be extremely knowledgeable regarding all details of any situation. Their depth of experience helps us resolve claims quickly. Our client service coordinator is quick to respond and amazing to work with. Our account representative is always right there to make sure everything is running smoothly and we always feel like we are her number one priority. There is nothing more we could ask from our third party administrator!”
Lesley R., HR Manager, Engineering Firm in Boise, ID
“We placed our first client with AmeriBen on January 1, 2018. The client is extremely complex and the AmeriBen team did an awesome job through the implementation process. Their attention to detail made what could have been a very tedious process manageable. It was truly a collaborative effort in getting their systems set up. Since implementation and throughout the year, the team continues to provide great service as well as guidance, when needed. When there have been issues, as there always are with any new vendor, AmeriBen’s team has focused on making it “right” for the client, and not making excuses. They are truly a great team to work with!”
Susan M., Sr. Account Executive, Brokerage in Watkinsville, GA
Experience the ease of MyAmeriBen.com from the convenience of your mobile device with the MyAmeriBen Mobile App. Review up-to-date claims status and eligibility information on the go, access your digital ID card 24 hours a day, seven days a week and contact customer service at the touch of a button. With the MyAmeriBen Mobile App, your account information is always on hand.
Held each year in early fall, AmeriBen's Annual Leadership Conference features a lively blend of formal education sessions and unique social activities. While the focal point is on learning and analyzing complex issues and trends in the fields of human resources and employee medical plan benefits, our ultimate goal is to foster an open climate of communication where attendees forge relationships, exchange ideas, and create solutions. Contact us or more information on the Conference,