Consultation

• Custom plan design for health, dental, and disability

• Evaluation of current health care administration program

• Assistance in determining proper level of and obtaining stop loss coverage

• Establish account handling and setup procedures

• Design and preparation of all forms for ongoing administration

• Ongoing consultation regarding plan design and required language

• Assistance in determining financial impact of benefit changes

Administration

• Processing and payment of claims

• Ongoing eligibility and billing services

• Toll-free phone to our customer service personnel

• Prompt and accurate claims services

• Performance Guarantees available

• Coordination of benefits (COB) with other carriers

• Interface with PPO networks, including repricing services

• Benefit recovery services

• Claims screened for filing errors

• Internal audit reviews for claims accuracy

• Provide outside medical consultants

• Outside audits performed on an annual basis

• Detailed monthly management reporting

• Annual plan review with management recommendations

• Plan Document and SPD preparation for counsel review

• Complete COBRA administration

• Actuarial Assistance of funding rates

• Recommendations for reserve levels

• Calculate post retirement plan liabilities
   

Accurate and timely response to employees’ health care claims is beneficial to employers, not only in promoting good employee relations, but also in developing cost containment techniques for health care programs. As with everything at Nyhart, our first step in designing the health care administration program that will best suit your needs is listening. One of our consultants will evaluate your current and potential needs to determine the best mix of our services for your requirements. The consultant can also aid you in finding the best source for the appropriate stop loss coverage.

An Accessible and Experienced Team

A team consisting of client, consultant, and our installation/administration staff works together to set up the procedures and preferences for effective account handling, including the benefit plan provisions. With accessibility being a key component of the service equation, you will be assigned dedicated claims, eligibility, and customer service personnel who are available via a nationwide, toll-free number.

We believe that the level of experience and training that we offer in the claims area is a definite value-added advantage. Our goal is to recruit claims analysts who have solid track records and a minimum of three year’s experience, then we enhance their knowledge in monthly training sessions. Through a sophisticated, automated, on-line system, we are able to create a high level of control and coordination.

Benefit plan parameters and limitations are pre-programmed into the system, including PPO options and reasonable and customary limits.

Medical claims, on the average, are processed in ten calendar days. This average includes claims which require coordination with other carriers as well as those requiring additional information.

We diligently pursue recovery of benefits from other plans. On the average, this accounts for 8% of the total claims paid for the year. Our system, using artificial intelligence programming, further screens claims for 39 potential filing errors that might cause otherwise undetectable overpayments.

Quality Control with High Degree of Accuracy and Efficiency

Strict quality control is a key feature of our service to which we have made a strong commitment. Our internal audit staff review the work of all claims analysts. Claims that exceed specified amounts or are questionable in terms of appropriateness of treatment are reviewed by outside medical consultants. Our claims analyst accuracy goal is 99% for financial accuracy and 98% for procedural accuracy. Outside audits are performed on both an annual and a monthly basis.

In addition to handling claims with a high degree of efficiency and accuracy, one of our goals is to provide each client with the information necessary to have an on-going evaluation of its plan. We furnish a detailed series of management reports and recommendations. A Nyhart consultant will work with you to interpret each report and modify the benefits appropriately. Our actuarial support staff can assist in determining what impact proposed changes will have in the areas of additional costs or benefits.

Nyhart is prepared to assist you with the full range of services applicable to health care administration. From the legal perspective, we can assist your legal counsel in the preparation of plan documents, amendments, and summary plan descriptions. We offer complete COBRA administrative services including actuarial assistance in the development of COBRA rates. The actuarial team will also calculate informational rates, make recommendations for reserve levels, compute post-retirement plan liabilities, and determine the financial impact of prospective plan changes.