Self-Funded Benefit Plan Claims Administration

By: HealthSmart  11/22/2011
Keywords: Party Administrators

In a self-funded plan, the employer assumes the claims risk. There is no insurance company involved. The employer’s liability is limited by a reinsurance company, who will reimburse claims that exceed a pre-set limit.

Most self-funded plans are subject to federal laws, including the Health Insurance Portability and Accountability Act (HIPAA), and the Employee Retirement Income Security Act (ERISA).  Wells Fargo Third Party Administrators operates in full compliance with all applicable laws and regulations.

Our self-funded plans include:

Keywords: Party Administrators

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Accountable Integrated Medical Management (AIMM

AIMM is a comprehensive, yet affordable, medical and risk management software tool we use to. Enhance the ability to contain and reduce rising employer benefit plan costs. This tool also incorporates every aspect of patient care. Enable benefit plan design and provider network analyses. Highlight and track “quality of care” initiatives.

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Additional Services

Even more products are available to meet the needs of your employees who elect additional benefit options. Flexible Spending Accounts for Health Care and Dependent Care Reimbursement. Concession Telephone Service Reimbursement Administration. Short Term Disability Claims Administration. Utilization and Case Management Services.

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Our Services

Our professionals work with you to analyze your plans, identify your needs, and design an effective and efficient employee benefit program that satisfies those needs within your budget. Wells Fargo Third Party Administrators is dedicated to providing outstanding products and services. We offer a variety of administrative and cost management services including.

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Cost Management Programs

A group of dedicated nursing professionals provides pre-certification, concurrent review, discharge planning, and case management services for customers wishing to monitor the inpatient, outpatient, or diagnostic utilization of their plan. Managed care alternatives are provided to our customers by bringing together leading network resources and continually assessing appropriateness of the networks to match the specific needs of employers.

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Support Products

Our interface with PPO and managed care networks provide both current employee eligibility, as well as current reflection of the providers participating in the network for optimal utilization of discounting arrangements. Our COBRA administration notifies qualified beneficiaries of continuation of coverage rights, election forms, termination notices, premium bills, and collection.