Claims Administration	IHS	Other
100% audit on claims over a set dollar amount, determined by auditing department
Random audits performed on all claims adjudicators
Claim Processing Standards
Statistical Accuracy 98 .0%
Financial Accuracy 99.3%
Processing Accuracy 98.0%
3-4 day claim turnaround time
Online Capabilities and Services
Online Claim Reporting
Online Claim Status & Inquiries
Claims System Editing Prompts
Duplicate Claim Alerts
Full Time Student Status
Coordination of Benefits
COBRA Payment Coordination
Medical Claim Review Department
Multiple Surgeries
Assistant Surgeons
Bundling/Unbundling
Over-utilization of services
Customer Service
Prompt and Efficient Service
Hold time less then 2 minutes
Direct contact with claim adjudicator
Courtesy Call to Plan Sponsor for claim payments that exceed a pre-determined dollar limit
Utilization Review
URAC Accredited National Organization
Online Capabilities (Real-Time in IHS's database)
Large Case Management
Trigger Diagnosis
On-Site Physicians and Registered Nurses
Intervention Programs
Funding Account
Option of the Plan Sponsor to maintain their own claims account, or to have the TPA maintain an account on their behalf
ACH Transfer Capabilities
Weekly Check Register Sent to Plan Sponsor via email
Enrollments/Changes/Terminations
Received, Processed and filed daily
Online Capabilities for Plan Sponsor
Plan Documents
Prepared by Plan Document Department, consisting of Paralegals and ERISA Attorney
COBRA/HIPAA Administration
DOL Final Claim Regulations
Federal Standards for Electronic Transactions (EDI)