Creating Healthier Benefits SM
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Health Care Administration

Health Care Administration

In an effort to control rising cost and to obtain more flexibility, in health benefit plan design, employers are continuously looking for ways to economize and improve cash flow without sacrificing coverage. Budget considerations, plan design and freedom of choice of providers each have an effect on the way employers fund their health benefit plans.

There are two basic approaches to funding an employer health benefit plan. These approaches are conventional funding and self-funding. In conventional funding the employer purchases a fully insured health benefit plan, the premiums are paid monthly in advance and the benefits are generally inflexible. With self-funding the employer assumes a portion or all of the risk in exchange for much lower premiums and the ability to design a benefit plan to meet the needs of their employees' and the company's budget. In a self-funded arrangement, employee claims are paid directly by the self-funded plan usually through the assistance of a Third Party Administrator.

For over twenty-five years Interactive Medical Systems has assisted employers in creating healthier benefits sm through self-funding. Following are some of the critical components needed to create a successful self-funded health benefit plan.

Plan Design and Implementation
The key to a successful program is good communication, organization, and flexibility to meet individual employee needs. Interactive Medical Systems provides the following:
  • Assistance to determine equitable rate structures for plan participants
  • All necessary forms, enrollment cards, and identification cards.
  • Booklet and plan document design and printing
  • Banking and accounting arrangements
  • Account representative assigned to your company
  • Participate in employee enrollment meetings

Plan Management
Interactive Medical Systems provides the following:
  • Managed Care programs including case management, utilization review, demand management, disease management, maternity newborn program, etc.
  • D2 Hawkeye predictive modeling software.
  • Monthly, quarterly and annual data analysis

Claims Processing
  • Highly automated flexible system
  • System accepts any form containing necessary claim information
  • Use national UCR (usual, customary, and reasonable) database to control provider charges
  • Three day turnaround on most claims
  • Trained personnel to respond to claims questions
  • Aggressive pursuit of coordination of benefits and subrogation
  • Electronic Data Exchange capabilities for enrollment and eligibility updates
  • On-line access capabilities to beneficiary and claim files

  • Reinsurance placement with "A" rated or higher carriers
  • Aggressive premium negotiation
  • Consolidated premium collection and remittance
  • Wide range of policy coverage options
  • Advanced funding available
  • Split funding options available
  • Aggregate accommodation available

Data Analysis

IMS has a unique, comprehensive data system that allows you to analyze such factors as outpatient utilization, length of stay, frequency of procedures rendered, and costs of services. Interactive Medical Systems offers you the ability to better manage your benefit program and it's costs through comprehensive, yet easily understood, reports. We automatically provide an array of standard reports for all of our clients and brokers. These standard reports include:

In many instances, insurance carriers and third party administrators are not providing adequate information. Often the information that is being provided is delivered only in a standard format for all clients. Interactive Medical Systems offers an interactive data base analysis package that allows us to analyze all aspects of your data and provide reports unique to your needs. With our interactive database, we can provide any report that will be helpful in managing your health care cost. Our analysis of your unique patterns of utilization allows future modifications of your benefits package based on your group's individual claims experience. At the initial implementation meeting, IMS will review the client's individual reporting needs and additional reports can be generated on a monthly, quarterly or annual basis.