A&I's full range of claims processing capabilities includes:

• Processing of medical, dental, mental nervous, and vision claims per NAIC guidelines
• Interactive, EDI, and batch adjudication functionality
• Daily processing for optimum turnaround time
• Payment release tailored to client's cash management specifications
• Geographic based Usual, Customary & Reasonable data (UCR)
• PPO network access and processing of PPO re-priced claims
• In-house PPO claims re-pricing available with most networks
• Dental pre-treatment estimates
• Comprehensive standard reports and full range of ad-hoc reporting capability

Our claims processing system allows us many advantages in efficiently administering health plans:

• Able to customize benefits at the employer level as necessary
• Tracks benefit limits based on visit limit or dollar limit
• Tracks benefit maximums by calendar year or plan year
• Usual, Customary & Reasonable percentile level customizable by client
• Customized edits for special claim handling and/or special audit needs
• Applies age and sex edits to diagnosis and procedure codes
• Includes rules for cosmetic, experimental, unbundled and obsolete codes
• Detects and pends possible or exact duplicates
• Detects and pends for no eligibility for immediate human intervention and follow-up
• Custom and standard letter functionality
• Identifies and flags participants and dependents for coordination of benefits
• Electronic batch loading of prescription claim data from Pharmacy Benefit Managers

Our system is setup and maintained on an on-going basis to run each claim through over 70 different edit and pend reasons. We also setup the system to pend individual diagnostic codes, procedure codes, and system coverage codes if appropriate and can pend by dollar amount, provider and operator controls.

We maintain a very strong relationship with our systems vendor as well. In fact our claims system administrator is a member of the committee for the vendor user group and therefore has a great deal of influence in the future direction of the product and well as included upgrades and enhancements.