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At Apex Data Systems we have a strong understanding of the group insurance marketplace, and have especially designed our group system structure to handle the unique needs of group processing. Offering a three-tier approach, our system delivers the flexibility to develop defined books of business, associations, or major employer units within which clients, groups, internal divisions or small employer units can be added. Certificate holders or members, along with their dependents can then be enrolled for capture of detailed employee-level data. Our knowledge of the group environment makes a real difference, and our solutions give you total support for true-group, self-funded group, associations, and METs. Products supported include term life, AD&D, dependent life, long and short-term disability, various types of health including standard, dual and triple-option major medical, dental, vision, prescription drug, and long term care. Processing is on-line, real-time, giving authorized users the ability to obtain accurate, up-to-date information about any insured group, employee or dependent at any time.
Administration System Features
Apex Data Systems offers unparalleled administration systems to perform all of your group administration needs including rating, underwriting support, enrollment, billing, cash receipting, premium posting, delinquency tracking, agent commission calculations, renewals, correspondence, and extensive standard and ad-hoc reporting. Features include:
Single invoice billing of premiums for coverages from multiple carriers while still maintaining the ability to automatically distribute payments for these various coverage's to the appropriate underwriters. Parameter-driven set-up routines that enable you to quickly and easily create new user-defined plan designs. A book of business field that gives you the flexibility to enroll groups and employees in user-defined pools of business for accurate and detailed management and profitability analysis and reporting. Flexible rating that can be established from user-defined tables including geographic load and discount factors, composite and average rating, and even manual rating for the greatest level of competitive premium calculations. Automated billing routines that make hard-copy list, self, and summary billing, payroll feed, EFT/PAC, bank draft, or lockbox processing simple to perform. Billing can be generated in either real-time, or in a deferred batch-type process. Full agent and broker information that can be captured down to the employee coverage level. Provision for commission calculations as flat or graded, including both years-in-force and/or premium volume, with up to 9 overrides and multiple splits at each level. Ability to track employee members as they move from one group to another. COBRA and HIPAA compliance. Internet connectivity for add-on web-based enrollment and benefits inquiry.
Claims System Features
Fast, accurate, and easy to use, our claims adjudication software solutions provide the features you need to increase your efficiency, control turn-around time, and manage benefit payments for all forms of life, health, dental, long and short term disability, and long-term care product-types. Our claims system can be installed as a fully consolidated solution, incorporating our administrative module, or on a stand-alone basis. Features of our group claims adjudication and management system include:
Dual and triple option, point-of-service medical, dental, vision, and prescription drug plans with user-definable PPO/EPO network benefits and discounts. Hospital pre-certification and managed care options. Mail clerk entry or enhanced EDI capture of submitted claims in a pended status for immediate tracking of claims details and production statistics, with associated lag reports and the availability of immediate on-line inquiry and adjudication assignment. A correspondence system that gives you the ability to generate user-defined letters and automatic follow-ups for up to 9 letters to the employer, employee, or claimant. Provisions for year-end reporting, including critical data for premium taxes, IRS submittals, and other accumulation-related output. User defined status, cause, service, termination and other codes that help you classify claims activity in a meaningful way, and help you manage and report on your claims experience by group or employee detail. Support for various pricing schedules that allow for electronic feeds, or entry of user-defined tables.
Repetitive payment processing allowing you to fully automate on-going payments based on product type, up to a scheduled review date. Production of checks, EOB's and letter or form correspondence to the group, employee, claimant, provider, beneficiary, or other. Internet connectivity for web-enabled inquiry of benefit payments, accumulation levels, and other data.
Other special features of our Group Administration and Claims systems are further described in our detailed Product Literature. Read on or contact us today for a hands-on, interactive system demonstration.
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