Eligibility Maintenance & Billing Capabilities
- Accurate maintenance of all necessary information including personal, general coverage and eligibility spans
- Retrospective additions and terminations
- Identification card preparation
- Unlimited plan and coverage changes including complete history
- Period based eligibility breakdown by Plan, Level, Employer or Agreement
- Premium and rate data maintenance
- Premium reconciliations
- Tracking of commissions
- Delinquency and eligibility collection
- LD and interest module to manage late payments
Exceptional Operational Performance
- Comprehensive reporting capabilities including custom reports and statistical plan performance reporting
- Regular quality review testing
- Data integrity
- Online repricing data for many Preferred Provider Networks (PPOs)
- Internal auditing
Successful Managed Care Programs
- Pre-admission review certification
- Large case management
- Built in Maternity Management programs
- Demand management
- Disease management
- Health risk assessments
- Nurseline
- Health information website
Claims Processing
- Medical, dental, vision, prescription and short-term disability plans
- Expert claims processing representatives reachable by direct phone and email
- Proprietary processing system with customization features
- Unlimited plan design options
- Client-customized Explanations of Benefits (EOB)
- Client-customized check stock
- Electronic claims acceptance from providers
- Systematic fraud detection
RDS Medicare Subsidy
- Coordination of RDS reporting requirements between BMGI, PBM and Medicare
HIPAA Compliance
- Privacy
- High tech security including
- 834, 835 & 837 files
- EGWEP and Medicare processing
Vendor Coordination
- Coordination with PPO Vendors & PBM's throughout the U.S.
Expert Customer Service
- Coordination of claims processing and customer service functions
- Experienced representatives assigned to each client
- Direct telephone and e-mail access
- Detailed claims investigation and timely resolution
