A&I has been auto adjudicating claims since 1998. Our years of experience in this automated environment have enabled us to refine our system edits and further increase the percentage of claims which are processed in this manner while also allowing us to set custom flags to edit, suspend or pend certain types of claims prior to release. On average, 60% of all claims entered into our system are auto adjudicated and are never touched by a human while the remaining 40% are handled by a processor or senior examiner or pended for further review.

In addition to the numerous system audits in place, we do a reasonability audit of all claims over $10,000, a supervisory audit of all claims over $20,000 and independent, dual full audits of all claims over $50,0000. We also do a random audit of 1% of all claims entered into the auto adjudication system on a weekly basis.

We can provide all of the documents and communication materials necessary to setup, implement and operate the plan on an on-going basis. All of our standard materials meet ERISA and HIPAA guidelines and are tailored specifically to the client’s identity and plan specifications. Our standard materials include:

• Plan document
• Summary Plan Description booklets
• Explanation of Benefits forms (EOBs)
• Announcement Materials
• Claim forms
• ID cards

We establish and provide all banking and accounting related to the administration of the health plan. Our services include:

• Establish a dedicated bank account for payment of claims and expenses
• Setup of standard funding schedule
• Online access with major banking partners
• Electronic funds transfer including ACH and wire transfers
• Daily positive pay confirmation of all checks issued
• Monthly bank reconciliation and account record keeping
• Electronic retrieval of cancelled checks
• Monthly reporting of financial activity
• State mandated surcharges