Customer Profile

Allegiance Benefit Plan Management is a Missoula, Montana-based company that has been providing benefits administration to employers for over 25 years. Since its earliest days, the company has been a leader in providing health and flexible benefit plans to employer groups and plan participants throughout the American West. They remain dedicated to one thing: outstanding customer service. That commitment continues through every solution they provide to their customers and to the vendors with which they partner.

The Challenge

When Allegiance selected LuminX in 1999, they had three challenges in mind: a need for electronic data interchange, a need to integrate their basic business operations and a need for more efficient auto-adjudication capabilities. "Some of these issues were essential in that they were mandated by regulatory guidelines, while others were operational efficiencies that would directly correlate to us providing the best possible service to our customers," said Dirk Visser, CEO, Allegiance.

Visser explained that having a complete source for various solutions gives Allegiance the flexibility they need to provide comprehensive administrative solutions that meet their customers' wide-ranging needs. "We have customers who need health benefits administration, others who exclusively seek reimbursement capabilities and others still who may need both types of administration. With this last group, we are able to virtually eliminate the need for multiple claim requests because we can integrate and adjudicate their flex claims without resubmitting a health claim. Ultimately, it's better for the employer and the user in terms of client satisfaction," he said.

The Solution

"There are software enhancements integrated into the solution that make our administrative services more attractive to our customers, who now benefit from sophisticated account analysis options that allow them to slice and combine data in a way that meets their needs," Visser said. Allegiance benefits from the combination of global remote access capability. Web accessible tools that provide online enrollment and eligibility maintenance and a robust reporting package with advanced business intelligence technology. "Combined, they make a very powerful tool," he said.

The Result

"Allegiance is an extremely efficient organization, and since 1999, we have become even more resourceful by using existing staff to handle substantially more business than we could on our prior platform," Visser said. "We've been able to integrate and consolidate our systems to create one source instead of continually moving in and out of multiple programs. Everything from enrollment and accounting to claims and reporting is all integrated and easy to access in one place," he said.

Case Studies - BeniComp®

CUSTOMER PROFILE

BeniComp® is a third-party administrator (TPA) based in Fort Wayne, IN. BeniComp Advantage - a unique program developed and administered by the TPA - offers a supplemental group medical insurance policy that works in conjunction with a high deductible health plan. It marries the best of consumer-driven health plan initiatives with wellness and disease management initiatives to give employees a way to earn credits that lower their "net" deductible as they lower their personal health risks.

THE CHALLENGE

BeniComp originally selected LuminX in 2000 to address the changes necessary for Y2K, as well as the issues related to fully integrated scanning services and auto-adjudication.

THE SOLUTION

In working with LuminX and learning about its offerings, BeniComp was able to develop and launch BeniComp Advantage. The dynamic plan building features and EDI capabilities of LuminX means BeniComp's billing, eligibility management and claims adjudication processes are practically worry-free. With 99% auto-adjudication through the system, BeniComp Advantage staff can focus on the sales, implementations and relationship management.

THE RESULT

LuminX gave BeniComp the ability to create new projects and new policies which have since become critical to their business model. Today they pay third-party administrator claims but also serve as the national back-office for New York Life, Security Financial Life and others. They recently received the highest quality rating possible from a national insurance carrier conducting an audit.

Case Studies - Insurance Design Administrators

CUSTOMER PROFILE

Based in Oakland, N.J., 30 minutes northwest of New York City, Insurance Design Administrators has become a recognized national leader in designing and administering self-funded health benefits plans by delivering what employers want most: manageable health benefits without the headaches and hassles of managing a benefits plan. As part of UHY Advisors, the thirteenth largest financial business service company in the U.S., IDA provides a full complement of Health Care benefit administration including actuarial consulting and legal services to their customers - including a full-time attorney on staff who can assist clients in dealing with changing regulatory issues that affect the delivery of healthcare benefits for their employees.

THE CHALLENGE

Prior to 1992, when they selected Acclamation Systems, Inc.'s LuminX to support their benefits management offerings, IDA struggled with technological shortcomings and information storage issues.

"We were concerned that we wouldn't be able to keep pace with the rapidly changing landscape in the health care industry," says Paul Sabina, President, Insurance Design Administrators. Sabina says his company was spending $100,000 a year on Microfiche, along with maintaining rows of cabinets reserved for hardcopy claim files, and a highly-skilled staff largely relegated to manual processes. With the changing regulations in health care, proprietary software was a concern: who would ensure the software was correctly coded to reflect the constantly changing state and federal laws and regulations?

As IDA grew, and their customers began requesting more sophisticated benefit designs that required the type of technology that was not available with the claims payment system they were using. Sabina had prior knowledge and experience with LuminX and began to look at it along with other vendors who he says tried to tell IDA what they needed instead of listening to them and providing a solution that met their needs.

THE SOLUTION

Today, IDA still faces the challenges of continuously changing regulations in health care, but they do not face those challenges alone. "LuminX's flexibility and software capabilities provide us with a peace of mind that cannot be achieved with proprietary software," Sabina says. "As state and federal laws and regulations change, the system is automatically coded to reflect those changes. ASI takes on the regulatory issues so we don't have to."

Sabina says that he is also pleased with the comprehensive set of modules that LuminX offers that support IDA's service offerings. "Whether a client wants an HRA, an HSA or managed care plan, LuminX has everything we need already built-in, and we receive automatic updates as the software is upgraded and improved," Sabina says. "With continuously upgraded software we don't have to wait for something new to come along. At the same time, if we need something, we have ASI's experience and resources to have it developed."

THE RESULT

IDA realized significant benefits by implementing LuminX. "Using a rules-based, automated system has dramatically reduced the time it takes to process a claim. We were able to reduce overhead and use our staff in more efficient capacities, eliminating many manual and semi-manual processes," Sabina says. He also points out the benefits of having fully integrated capabilities for everything from scanning to EDI to claims processing.

For IDA, what sets LuminX and Acclamation Systems apart is that the management team really listens to the customer. Sabina praises the company's client services and hands-on management style. Recently, when IDA was migrating from an in-house solution to an ASP model, IDA's server was unable to accommodate the program changes. "So they shipped us a server and set it up. When we switch exclusively to the ASP, we'll ship it back. But in the mean time, we don't have to worry about the system interfering with business. Their management team listens and takes a personal interest in our needs," Sabina says. ""When something happens, you need a team behind you who can respond quickly and make things happen to resolve the situation." Sabina says. Visit Insurance Design Administrators, a UHY company, online at www.idatpa.com.

Case Studies - Tim Davis & Associates, Inc.

CUSTOMER PROFILE

Centrally located in Elizabethtown, Kentucky, south of Louisville, Employee Benefits Administrators, a division of Tim Davis & Associates, Inc., is a benefits administration firm with the resources and experience to respond to virtually any employee benefit-related need from day-to-day administration of a self-funded group health plan to identifying a provider network in another locale.

THE CHALLENGE

In evaluating solutions, a few things stood out to the company, among them, they needed a solution that gave them the ability to process and adjudicate claims faster; they also wanted a solution that would help them streamline the office to create a virtually paperless environment. "It's important to our customers that we provide a quick processing and turnaround time to remove the possibility of missing HIPAA deadlines. When we're more efficient, our self-funded customers are happier," said Marc Sanborn, Vice President and Chief Information Officer, Tim Davis & Associates, Inc. And naturally, they needed to be able to ensure that when they needed specific functionality, it was available or could be developed, and that a team of customer service and technical experts would be prepared to respond to the updates Tim Davis & Associates, Inc. required, in a way that did not disrupt the service to their customers.

THE SOLUTION

Employee Benefits Administrators ultimately selected LuminX. "We have the ability to offer many types of plans and benefit packages - and adjudicate all of them out of LuminX," Sanborn said. They can offer clients an HSA or standard health plan, and can support any combination of health/vision/dental. "The flexibility of this solution allows us to serve as a TPA for medical plans as easily as the back room for a fully-insured vision company. We're able to meet a larger variety of customer needs," he said.

THE RESULT

Employee Benefits Administrators has continued to realize results over the past six years. Initially, the implementation allowed their staff to reorganize duties to spend less time manually paying claims and more time on customer service. "The solution allows us to be less focused on getting claims out the door and spend more time providing a much higher level of customer service, which our clients notice and appreciate" Sanborn said.

"With LuminX we can also create other revenue streams, such as consolidated billing services. Whether our customers offer medical, dental or flex accounts, we have to be able to invoice them. We've taken this experience into consideration in developing a product that allows companies to enroll all of their benefits online and we can bill them and forward the proper payment to all the third parties they use, while only minimally increasing our FTEs," he said.

Tim Davis & Associates is able to provide their clients dramatically enhanced customer service, increase client share and add more jobs to the local community. "I can go to current clients and provide consolidated billing for life insurance and other needs in addition to their health/dental/flex, and in doing so provide them the convenience of one trusted relationship instead of three," he said.

And LuminX meets the company's original desire to have the control they require over their software, the functionality offered, the upgrades, and when the implementations take place - ensuring the support they need and no unpleasant surprises for them or the customers they serve.

Case Studies - Verity National Group

CUSTOMER PROFILE

Based in San Antonio, one of America's premier, multicultural cities, Verity National Group, a third party administrator specializing in data management and business processes, provides their customers with a wide variety of benefit options backed by the technology and speed of a much larger company. Verity National, which has served public and private employers for nearly 20 years, specializes in administering medical, dental, vision, disability and other insurance benefits while helping organizations practice self governance through state-of-the-art benefit plans.

The coordination of reinsurance, network, pharmacy, lab, wellness, disease management, medical case management, and pre-certification are all services that Verity National provides. They also consolidate online benefit eligibility and billing for group coverage. To provide their customers with consistent, quality service, they draw on five performance measures including: extraordinary personal attention, a passion for speed, uncompromised accuracy, technological strength and a team of experienced executives and employees.

THE CHALLENGE

In 2005, Verity National Group was spun off of a much larger company which had grown largely through acquisition. Verity National Group's executive team came together from diverse corporate backgrounds, where they shared one thing in common - a respect and understanding for the value of sophisticated technology. "We're big enough to provide customers with the depth of products and service they require, but small enough to provide a genuinely intimate relationship - something for which our team is regularly complimented," says Laurie Burke, president and chief financial officer, Verity National Group.

Prior to the spin-off, like many third party administrators, Verity National found themselves in need of a comprehensive claims processing solution. Two of the companies they acquired were licensing Acclamation Systems' LuminX solution, and when they ran due diligence on each of the systems, they found that LuminX was faster and more robust than both proprietary and custom-designed solutions.

"Claims processing comes down to time and money. As a TPA, we manage money for other people. When it's your job to make things flow, it's important to have a system that moves quickly and has the support of a strong company behind it," Burke says. Verity National needed a system that would allow them to cross train employees and to provide them the tools to work faster and more efficiently.

THE SOLUTION

Verity National Group cross-trains their employees because they realize that even the best processors cannot take customer service calls if their goal is to process 400 claims daily. By creating a comprehensive database of information and segregating duties, employees can focus on achieving their daily goals. Customer service reps have access to the customer's complete file, while processors can focus on claims. Verity calls it single call resolution. "All employees are cross-trained on duties and all information is cross-referenced on the screen. You'll never hear us say that we have to go retrieve your file or talk to a processor," explains Burke.

"We can accomplish more work with fewer employees," Burke reports. She says the equation is simple, "If we process more claims in less time, we don't need as many employees. Our overhead is less and we pass the savings on to our customers." She credits LuminX with providing the technology and speed, and her team with bringing a great work ethic. "When you combine these things, what normally can take ten days takes us a matter of hours. We don't have a backlog of claims. Our processors know that their day is over when the claims box is empty," she says. "We can't cut the check until it's funded by the client, but in most cases, we can promise that the claim will be scanned, adjudicated, processed and on the list for payment within one day."

THE RESULT

Today, Burke is not afraid to make and live up to bold promises to her clients. "Our customers can select any day of the week, and they will get a request for funding on every claim we've processed in the past week. If a customer's RFF [request for funding / billing request] day is Friday, and we receive a huge batch of claims on Thursday, those claims will be processed in time to appear on Friday's RFF report," she says.

"Our employees can process about twice the number of claims as our competition, resulting in productivity measures we pass on to customers in terms of lower rates and cost savings," Burke says. "When a large hospital sees how quickly our customers' claims are paid, they may reward our faster service with increased savings on services to our customers. By working faster and more efficiently, Verity National can earn them greater discounts than the TPA down the street." To learn more about this customer, visit www.veritynational.com