Claims Payment System (Cont')

We utilize Trizetto, Inc.'s "Rims" claims processing system to process and pay more than $60 million annually in medical, dental, vision, prescription, disability and flexible spending account claims. More than 400 users of this system utilize it to process 60% of the medical claims paid in the United States. It is well supported and continually upgraded to address such issues as HIPAA EDI, Privacy and Security mandates. This fully automated system has a significant number of crosschecks built into the system to ensure unusual or significant claims are reviewed before payment is made.

Claims and eligibility records are maintained in their lowest form, which facilitates custom reporting and data transfers. Electronically transmitted eligibility files are provided on a monthly basis to outside prescription, dental and vision carriers for accurate administration of those programs. At the same time, a participant's entire family's claim history is retained in the system and available for review.

We also contract with Advance Business Fulfillment (ABF) for producing and mailing health benefit claim checks and explanations of benefits. ABF is the largest outsourcer of these functions for health plans as it processes more than one million pieces of mail per day. In addition to the substantial volume discounts it receives in postage and printing, ABF's highly advanced technology allows it to consolidate mail to the same address resulting in even greater savings. Its systems and processes provide us with assurance that there are maximum data integrity and security controls.

 

<Prev                    Next>