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Claims Analyst dedicated to your account
The same analyst will process claims and answer claims inquiries. We believe it is very important to have the person who makes the decisions regarding payment of a claim provide answers to questions raised by you and your employees.
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Balanced approach to claims analysis
The ABA claims system utilizes computer software that combines
integrated claims processing, participant eligibility, claims files, claims history, and the billing system into one package. This allows ABA to access all records and print up-to-date reports on demand, in a number of formats. In addition, the claims analyst reviews claims outside the automated system to ensure that they are properly evaluated. This is done in a timely manner and reduces the opportunity for payment of non-qualified claims.
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Claims Processing
ABA processes claims and generates claim checks and Explanation of Benefits forms weekly. Claims checks are released approximately 48 hours after funds are received from the employer.
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Retention of professional medical and dental consultants
ABA uses the same medical consultant that is used by major PPO and Utilization Management programs in this area.
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Custom Plan Document Creation
ABA will assist in developing a custom Plan Document that will conform to ERISA plan requirements and the particular needs of your
group.
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Competitive Stop Loss Coverage
Your Stop Loss Coverage will be put to bid each year with top quality
reinsurers. Quotes will be reviewable by you, and the process is designed to obtain the most cost-effective coverage each year. ABA avoids using only one or two "favorite"
reinsurers, believing that is not in the best interest of the employer. We are aggressive in our search for the best
pricing and coverage. We do not receive commission on Stop Loss Coverage.
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Preparation of Employee Books
ABA will prepare employee books that are a complete copy of the Plan Document, providing all plan information to each employee. ID cards and Summary Plan Descriptions are also prepared.
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Detailed List Billing Monthly
ABA submits a detailed list billing each month showing all premiums and fees. This provides a monthly summary of who is covered under your plan. Upon request, we will include the fees for other coverages such as Life, LTD, etc. upon which ABA does not pay claims. ABA collects the combined premiums and fees and remits the proper payments to each insurer and service provider.
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Assistance with IRS Form 5500
Self-funded employee benefit plans are required to file a Form 5500 with the Internal Revenue Service each year. ABA assists you by providing required plan data that is available to ABA.
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Web-Based Information for Employees and Employer
ABA offers a specified website for your use. Employees can view the complete Plan Document and access any other information which you, as the employer, wish to make available to them. Through a secure, password protected area of the site, designated members of your staff can access some or all of the extensive reports generated by ABA, for printing or downloading of the files. This program provides many benefits to the employer and is available for a modest set-up fee.
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