TPA Administration
Apex’s flexibility and expertise allows you to develop a benefit package unique to your employees’ needs. We can help develop a customized product offering that best meets the current and future needs of your company. Our goal is to ensure your needs are met and the goals of the employee benefit model are realized.
We administer both basic medical, dental and vision plans, as well as highly complex, customized plans unique to your business needs. We can also tailor plan designs that uniquely integrate medical, pharmacy and medical management.
Product Highlights:
- Accurate and timely claims administration using the latest technology
- Comprehensive, detailed reporting services available online
- Benefit Administration of medical, dental and vision plans, including consumer-directed health plans
- Benefit design services
- Integrated Health & Wellness Services, including Condition Management, Wellness Services, Care Management and Utilization Management and Large Care Management
- Pharmacy Benefit Management
- Convenient online enrollment and claims information through Plan Central
- Knowledgeable and experienced Member Services representatives
- Access to national and regional PPO provider networks
- Efficient membership billing and eligibility verification
- Coordination of benefits
- Student eligibility verification
- Customized plan materials, including Member ID cards
Solutions offered:
- Stop loss/reinsurance coverage
- COBRA administration
- Flexible Spending Account (FSA) administration
- Subrogation
- HRA & HSA administration
- Network management
Technology
Significant investments in industry-leading technology has allowed Apex Health Solutions to utilize a robust, state-of-the-art claims system, as well as an integrated predictive modeling application that incorporates medical and pharmacy claims.
In addition, our Case Management System incorporates utilization management, disease management and telemonitoring services to provide an integrated personal health record for members. This technology allows our care coordinators to see the whole picture when providing service to members.