The integrated ancillary products in Virtual Benefits Administrator offer unparalleled functionality and scalability with seamless, real-time integration with all system components.  Utilizing a modular design, Virtual Benefits Administrator can independently or collectively administer Medical, Dental, FSA, Disability, Vision and Medicaid/Medicare lines of business.  Visit our products and solutions area to learn more about how Virtual Benefits Administrator can fit your needs.  The ancillary products include:

 

Capitation

 

·         Capitation paid based on Member or Subscriber

·         Age and sex based capitation rate tables

·         Capitation can be paid to multiple providers (i.e. PCP, Specialty Groups, Clinics, Facilities)

·         Capitation checks generated by Payor code

·         Capitation detail report showing amounts paid to Provider per Member

·         Primary Care Provider (PCP) Assignment by Member

 

Billing

 

·         Invoices generated by Group and/or Division, with the capability to invoice directly to the Subscriber

·         Premiums calculated by Subscriber based on rates in Division Contract

·         Payments received entered against original invoice

 

Commission

 

·         Ability to pay commissions to any number of agents as well as the ability to set the percentage split on commissions paid.

·         Individual Business processing allows for agents to be assigned directly to the member when paying commissions

·         Broker/Agent commissions by Subscriber or Member calculated on a per-member-per-month, per-employee-per-month, percent of premiums billed or percent of premiums received.

 

Credentialing

 

·         Unlimited user-defined ID fields for each Provider, to accommodate UPINs, Tax IDs, Medicaid or Commercial IDs, and more

·         The database holds Provider demographics, Location, Malpractice, State License, Quality, Contracts, and Re-Credential date information.

·         Networks and Fee Schedule data can be maintained

 

Reinsurrance

 

·         Reinsurer/Stop Loss Contract tracking at the policy level with a great deal of flexibility, including shock loss tracking and reporting at the Member level

·         Aggregate and shock loss reports

·         Claim generation and submission forms

·         Allows for tracking of receivables

·         The database holds reinsurance contract information, i.e. contract length, lasers, coverage exclusions based on benefit and procedure codes.

·         Note feature specifically for Stop Loss area

 

Notes / Call Tracking

 

·         Extensive call tracking features that allows for the entry of name of the person calling, telephone #, caller type, reason for the call, call status, and notes for documenting details

·         Note-taking field with free-form entry attached to Subscribers, Members, Groups, Providers, Authorizations, and Stop Loss Contract area records-includes “Spell Check” functionality and the ability to attach document images

·         Scheduler of events, for future one-time and/or repetitive events

·         Instant retrieval of scanned documents associated with claims

·         Ability to View and/or Edit any attached files in notes, depending on security level

·         Provides for efficient customer service such that most calls can be handled without the need for call-backs or long wait-times for Members; >95% of information is readily available

 

Authorization

 

·         Referring Provider and Attending Provider tracked for each Authorization

·         Requested vs. Approved vs. Actual Visits, Dollar Amounts, and Timeframe captured

·         Approvals, Pends, Denials are tracked with reason codes

·         Unlimited Diagnosis Codes can be identified with each authorization

·         Capability to specify “allowed” Procedure Codes

·         Supports E-mail of approvals to Requesting Provider

·         Notes functionality attached to Authorizations, referencing Member and/or Provider notes from within the Authorization area

·         User-defined medical algorithms available

·         Authorization search by Authorization number, Subscriber, Member or Provider

·         Authorization requirement defined by Place Code within Benefit within Plan within Contract

 

Reports

 

·         Enrollment reports (detail and summary)

·         Claim Utilization

·         Claims Payable reports by Payor

·         Easy accessibility to data for reporting by any ODBC compatible reporting tool such as Infomaker, Crystal Reports, Microsoft Access or Excel

·         Explanation Of Benefits (EOB) and Remittance Advices produced with or without pended claims included