Services
Benefit Management Administrators, Inc. provides a broad-spectrum
of TPA services to self-funded clients nationwide. Click
on any of the links below for more information.
Claims Administration
Customer Service
PPO Networks
Reports
Additional Services
Claims Administration
The medical, dental and vision claim processing function
is the heart of BMA. At BMA, we provide outstanding
claim management services achieved through superior
processing accuracy, unmatched claim turnaround services
and equitable pricing.
The claims adjudication process includes the following
range of functions:
- Specific and Aggregate Stop
- Loss limits
- On-line Eligibility and Coverage History
- Automated Batch Adjudication
- Automated Production of Checks and EOB forms
- Automatic Claim Hold for Quality Reviews
- Duplicate Payment Edits
- Reasonable and Customary Edits
- Automated Correspondence
- IRS 1099 Reporting
- Multiple PPO Contracts
- Benefit Plan Design and Document Preparation
- Check Payments Tied to Customer Funding Arrangements
- Claim Edit System
- Call Center
BMA offers the following cost containment features:
- Eligibility dates prompt for pre-existing
- Termination date can be input prior to the actual
date
- Benefits are pre-loaded
- Prompts for Pre-Admission Review & Second Surgical
Opinion
- Tracking frequency of examiner overrides of system
edits
- Claimant and Provider prompts
- R&C updates for all codes
- History maintenance of deductibles, out-of-pocket
and carryovers
- Over-utilization (reports)
- Claim dollar maximums
- Necessity of assistant surgeon
- Diagnostic procedures
- Pre-Existing Conditions
- Coordination of Benefits (COB)
BMA’s claim paying system has an extensive plan building
or plan abstract section allowing for customization
of all plan designs. The Abstract section controls the
claim processing function so that the deductibles and
all other accumulator information are updated automatically
as the claims are processed.
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Medical
We administer a variety of self-insured medical benefit
plans including PPO, HMO look-alikes, and indemnity
plan designs for clients nationwide. Our tailored administration
services provide our clients with flexibility and control.
We have access to health care networks nationwide and
utilize a URAC accredited pre-certification program.
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Prescription
BMA’s prescription drug card program provides employees
with substantial discounts. Our program includes:
- Monitoring and review of drug card utilization
- Participating pharmacies nationwide
- Online computer links between participating pharmacies
and the prescription drug card administrator
- Flexible plan design
- Mail order options for convenience and even deeper
discounts
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Dental
BMA's traditional dental programs give employees the
freedom of choice with regard to dental providers and
allow total flexibility in plan design. We can customize
co-insurance levels, deductible amounts, annual maximums,
and benefits covered to meet clients' specific needs.
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Stop-Loss
Stop-loss insurance is arranged to protect self-funded
employers against extreme risk. Employers can choose
the amount of risk to retain and the amount to cover
by stop-loss insurance. There are two different parts
to stop-loss insurance for self-funded health plans:
- Specific stop-loss to limit the employer’s
cost for eligible medical expenses for each covered
individual.
- Aggregate stop-loss to limit the employer’s
overall annual costs for a self-funded health plan.
BMA provides services for clients interested in pursuing
stop-loss coverage. Through our established relationships
with several A+ rated stop-loss carriers, we obtain
competitive stop-loss quotes as part of our comprehensive
proposal package.
Click here to review the list of information necessary
to receive a stop-loss quote.
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Customer Service
Our Claim/Customer Service representatives are devoted
to our client’s needs. Each representative is responsible
for handling all incoming phone calls from the participants
or employer contacts. Additionally, the representatives
handle all incoming provider calls regarding benefits
and claim payments.
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PPO Networks
BMA is ready to meet your organization's health care
needs - whether you have employees at a single location
or at multiple locations nationwide. We work in concert
with clients to find positive solutions to their health
care plan objectives. We find a balance between employee
access and cost savings beginning with in-depth accessibility
studies, continuing with ongoing reviews of network
options to ensure the best match of health care networks
for employees.
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Reports
BMA provides a wide variety of operational reports
through our interactive website. These statistical and
financial reports are formatted, compiled and classified
based on our client’s individual plan.
Standard Monthly Reports include:
- Active COBRA Report
- Active Member and Dependent Report
- Aggregate Report
- Benefit Analysis Report
- Billing Detail
- Charge Type
- Charge Type by Month
- Check Run List Report
- Claim Payment Summary Report
- Claims Analysis Report
- Claims Paid vs. Incurred Analysis
- Eligibility
- Geographic Distribution of Membership
- List Check (List all outstanding checks which have
not been printed.)
- Members by Age
- Payment by Zip Code
- Payment Report- Pending Report
- Relationship Report
- Specific Report
- Top Providers Report
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Additional Services
At BMA, we can provide administrative support services
so our clients can focus on their employees' personal
needs. Please contact us for information on the following
additional services offered by Benefit Management Administrators,
Inc.
COBRA/HIPAA Administration
Section 125 – Flexible Spending Account
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