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 table
• 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 member-per-month, 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

Reinsurance

• 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