Our Services
TPA FULL SERVICES - Every claim is reviewed by both management and seasoned claim adjusters rather than claims being primarily paid under standard industry procedures called “batch adjudication” similar to credit card transactions. Claim administration is available for Medical, Dental, Vision, STD, LTD. Large case management and utilization review are provided at no additional charge by our R.N. and key administrative personnel. HIPAA and COBRA services are customized by client.
REINSURANCE - We offer full reinsurance contracts that “follow the Plan” language without separate exclusions. Denied reinsurance claims have been virtually non-existent for over 25 years. Our primary carrier has never cancelled a client at renewal due to large ongoing claims. We are the only approved TPA in Peoria for Symetra Life (formerly Safeco Life)--an industry leader in reinsuring self-funded medical plans the past 25 years.
PROVIDER CONTRACTING - Over 1700 physicians in Central Illinois participate with us in our CONSUMERCARE® program to remove the surprise from charges and allowances not always being the same. A current listing of participating physicians is available HERE. This program allows a free choice of physician without Plan penalties and is popular with many client groups. We also arrange agreements directly between client groups and local hospitals as desired. We utilize numerous PPOs primarily for care outside of Central Illinois.
STRATEGIC HEALTH PLAN CONSULTING - Our clients traditionally spend $1,500 or less per year per employee using methods and strategies that we created. Some of our cost control methods can be used where we do not handle the everyday claims for a client. Consulting fees can be either hourly or contingent on amounts saved.
REINSURANCE CLAIM OFFICE CONSULTING - Our assistance is available to help reinsurance claim offices control their largest and most difficult claims.
PRESCRIPTION PLANS - We are the Central Illinois intermediary for the nation’s largest pharmacy benefit manager…Medco, serving over 65 million Americans.
GROUP LIFE, SUPPLEMENTAL LIFE & AD&D, INSURED STD AND LTD - Coverage is handled by our office.
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