Virtual Benefits Administrator is a comprehensive benefit administration system and claims processing software solution designed for health plans and benefit administrators. Virtual Benefits Administrator is a rules-based software solution designed to administer complex benefits offering un-paralleled functionality and scalability with seamless, real-time integration with all system components. Through continuous development in response to client requests and industry changes, Virtual Benefits Administrator provides a low cost of ownership easy to use system. In addition to the integrated ancillary features the application includes:
- Member Eligibility that includes demographics and their relationship to plan sponsors/group, benefits, providers, other insurance (coordination of benefits), accumulators and user defined unique ID numbers.
- Plan Sponsor/Group information that includes contact information, with the ability to further define different divisions, payor identification at various levels, multiple benefits available and group billing.
- Provider component that includes contact/address information, credentialing, networks and fee schedules, payee identification, and unlimited user defined fields for ID numbers.
- Customer Service is easily administered with the single database that holds all free form notes entered and call tracking information, schedule of events, and retrievable scanned documents.
- Claims Processing support for medical, dental, vision, repricing and pharmacy services and seamless integration with Eligibility, Groups, Providers, Customer Service all other functional areas of the application. Auto adjudication of claims with cost containment and edit checks built in the system.
- Benefit Plan flexibility allows supports varied and the most complex benefit-plans. Calculation of maximums, in-network and out-of-network services, limitations, defined authorizations, procedure codes within a benefit type and seamlessly linked to groups and members.
- Security built for each user in the Virtual Benefits Administrator application. Security levels are set to access ‘areas’ of the application as well as the dollar limitations in the claim payment process.
Ancillary features include;