Medical Claims Processing

AmeriBen/IEC Group provides claims processing and administration for all of your benefit needs including medical, dental, vision, flexible spending accounts, life and short term disability.

PPO Access
AmeriBen works with many national and regional PPO’s and has the expertise to manage larger employers’ plans because of our ability to effectively manage these relationships. We understand that deep PPO discounts offer significant savings to our clients and we work proactively to identify the strongest networks by geographic location. We also work to achieve directed and non-directed discounts in addition to fee negotiations at the provider level.

”Wrap” PPO Network Administration
AmeriBen/IEC Group has established relationships with external cost-containment vendors in an effort to provide additional cost savings to clients through discounts on out-of-network claims. These discounts are provided by means of supplemental network "wraps" and/or negotiations with non-contracting providers & facilities. Many of our clients have realized thousands of dollars of additional savings by accessing a supplemental/”wrap” network.

Electronic PPO Repricing
Electronic claims are reviewed for eligible participation in a PPO plan. Those claims are then sent via EDI to the appropriate PPO for pricing. If a claim is rejected, the claim may be routed to a secondary network for potential out-of-network savings. All of this is done without manual intervention in as little as 4 hours, dramatically reducing the time to accurately process a claim.

Fraud & Abuse Detection
AmeriBen has partnered with HealthCare Insight (HCI) to provide unique fraud and abuse detection and prevention services. HCI offers proven savings, using manual and automated real-time processes, averaging 2%-6% of health care expenditures.

Audit of Large Dollar Claims
All claims processors are subject to extensive and thorough audits by AmeriBen/IEC Group’s internal audit department. These audits are performed on all claims with a provider disbursement exceeding $5,000, prior to disbursement. In addition, a random statistical sample (approximately 3% of previous day’s claims) is conducted.

Coordination with Pharmacy Benefit Managers (PBM’s)
AmeriBen/IEC Group has partnered with several top-ranked, nationally-recognized prescription benefit managers (PBM’s). We interface with most of these PBM’s on a daily basis, sending eligibility electronically. AmeriBen/IEC Group’s Account Representatives and Client Service Coordinators have access to dedicated Account Managers and Client Service Teams with these PBM’s for quick issue resolution, as well as recommendations on plan design.