Our Processes Are Better than Magic.
They are Real.
They are Real.
Nexcaliber Shares Risk with Our Clients as We Earn a Percentage of Savings of the Benefit Outlay while Providing the Checks and Balances below.
- Inquiry Verification
- High Risk
- Summaries / Reports
- ERISA Compliance
- Benefit Adjustments
- Stop Loss / REIN
- Benefit Communication
Confidential. Maintain current, complete and confidential records and files of claims for each covered person for determination of plan benefits and satisfaction of deductibles.
Adjudicate.Adjudicate all claims in accordance with the benefit levels and provisions of the self-funded plan document, including determination and administration of reasonable and customary charges, the coordination of benefits with other group plans, appropriate claim control practices, and request forms for obtaining additional information.
EOBs.Prepare and distribute benefit checks and explanation of benefits to employees, employers, and/or service providers.
Inquiry Verification. Verify and handle inquiries from the employer, employees, hospitals, doctors, and other service providers concerning requirements, procedures, or benefits of the plan. Verification of benefits is done in writing via facsimile or electronic signature. Written verification protects our clients as well as Nexcaliber.
High Risk Claims. External audits of high risk/high potential claims.
Summaries / Reports. Provide periodic claim summaries and reports.
Reporting. Complete and submit all premium reports, statements, claim reports, and other reports required to all insurers and reinsurers of the plan.
ERISA Compliance. Provide information necessary for reporting of ERISA 5500 forms.
Benefit Adjustments. Provide assistance in evaluating and implementing benefit additions or modifications.
Stop Loss / REIN Provide assistance in obtaining competitive Excess Risk Insurance (Individual and Aggregate Stop Loss Coverage) quotes at renewal.
Benefit Communication. Provide claimants with a toll-free 800# telephone number to inquire about coverage, the status of a claim, or any other suggestions they may have. The representative has immediate access to the database in the on-line system as well as any hard copy files that were submitted. Providers may also discuss the extent of coverage for anticipated services.