Explore Our Claims Administration Services
Comprehensive and efficient claims administration tailored to your unique requirements
Our Services
Alpha Isle Services specializes in high-quality, expedited back-office claims management.
Whether you need full-time claims staff or support during peak seasons, our comprehensive claims management services are designed to meet your needs effectively.
With AIS, you can rely on responsive, accurate, and timely administration. We apply appropriate contractual provisions, plan specifications, case management resources, and established claims practices to each medical claim, ensuring proper reimbursement or denial.
- Claims Intake
- Notice Tracking and Notification
- Document Management
- Payment Recommendation
- Reinsurance Reporting & Tracking
- Customized Reporting
- Participation in Implementation Calls
Managing Claims Workloads
AIS operates with a standard of a 10-day turnaround for claims.
If your current claims backlog exceeds this timeframe, AIS can help bring your claims processing back under control. We handle overflow efficiently, ensuring you stay within industry standards and avoid potential service issues with MGUs, producers, and insureds.
Operational Assessments
With extensive experience in running medical stop loss claims departments, AIS is well-equipped to consult on the operations of MGUs or insurance carriers’ claims departments.
An insurance carrier granting claims authority to an MGU will have a right to audit the MGU’s claims handling practices, but equally an employer or a captive which is responsible for payment within a specific and/or aggregate layer will want assurance that claims are being managed appropriately and payment are correct.
- Setting Up Claims Departments
AIS assists in establishing claims departments by providing procedural manuals and guidance on staffing and technology needs. - In-House Claims Administration
For those transitioning to in-house claims administration, AIS offers support in managing and overseeing your claims team to ensure smooth operations. - Periodic Assessments
AIS provides periodic operational assessments or check-ups to identify areas for improvement in your claims department.
Medical Underwriting Reviews
AIS introduces medical underwriting review services.
The company’s clinical resources are now available to assist you with both renewal and new business underwriting for existing and prospective AIS clients.
- Review of high-cost claimants with estimated treatment costs
- Evaluation of course of treatment
- Full outsourcing of medical review services
- Overflow resource for busy season or absences
Case Management
AIS provides case management coordination and navigation services for all single parent captive clients.
These services are provided in conjunction with case management services provided by the employer’s TPA and specialist vendors on the program. AIS also coordinates with the case management and specialist services provided by or available through carrier partners.
The goal of our case management services is to ensure that all medical stop loss claimants are receiving quality treatment at an affordable price to manage the employer’s total cost of care.
- Review of all 50% notices of stop loss claims for treatment program.
- Discussion and coordination with TPA, carrier, and vendor for agreed course of treatment.
- Introduction and referral to specialists outside of the program vendors as needed, i.e. filling gaps for treatment options
- Monitoring of claims for on-going treatment and case management options in conjuction with program vendors.
- Maintaining on-going relationships with specialist medical vendors for use on client programs.
Claims Audits & Reserve Analysis
In the employer stop loss market, various stakeholders need assurance that claims are reserved and paid correctly.
AIS, with its specialist claims administrators, offers extensive experience in managing stop loss claims and conducting thorough audits.
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Large Individual Claims:
Ensuring accuracy and appropriateness in handling large claims. - Periodic Audits:
Regular reviews of claims departments to maintain high standards. - Aggregate Claims Review:
Comprehensive audit of aggregate claims to confirm correct handling and payment.
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