Third Party Administration and Cost Containment Solutions

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AMERICAN GROUP ADMINISTRATORS, INC.
Third Party Administration and Cost Containment
Solutions

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Who We Are

• American Group Administrators, Inc. is a
  national organization with a commitment to
  providing quality administration of claims, and
  management of client dollars utilizing
  state-of-the-art technology and reporting while
  providing exceptional customer service.

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Employee Benefits Administration

• Claims Administration
• Medical, Dental, Vision, Rx Short Term
  Disability
• Client Look-up Privileges
• Subrogation, COB
• Enrollment Services
• COBRA HIPAA administration
• Eligibility coordination with vendors
• Consolidated Billing
• TPA fees, PPO fees, Reinsurance premium, etc.
• Premium Billing Collection
• No group size minimum
• ERISA Plan Document Preparation

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Custom Designed Programs

• Analyze Client Data to develop Plan Design
  Options
• Maximize Client benefit dollars
• Ensure Plan participant satisfaction
• Determine client Risk Tolerance
• Secure reinsurance through established
  relationships with A rated carriers and MGUs
• Provide cost analysis of Self-funding

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Cost Containment through Partnerships

• Recommend PPO Networks for optimal savings
• National
• Regional
• PPO Network Selection
• Zip Code analysis
• Savings analysis
• Pharmacy Benefits
• Relationships in place with major Pharmacy
  Benefit Management Companies
• Encourage use of generics
• Provide Drug utilization analysis

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Effective Utilization Management

• Detailed data integrated with Case Management
• Early identification of patients for Case Mgmt.
• Utilization Review Partners
• Action Healthcare
• American Health Holding
• Intracorp
• Large Case Management
• Integrated with claims system
• Over 1500 ICD-9/CPT codes flagged for referral to
  Case Management

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Ease of Administration

• Electronic Enrollment for Open Enrollment
• Group meetings or One-on-One enrollment sessions
• Internet/Intranet capabilities
• Increases accuracy of information
• Increases employee understanding of benefits
• Enrollment maintenance via Internet
• Client establishes Rules

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Processing System WLT Software

• Integrated Solution for Claims Customer Service
• HIPAA Compliant EDI Processing
• Extensive Reporting
• Standard reports
• Benefit Utilization
• Benefits Paid By Month
• Aggregate and Specific Tracking
• More available
• Ad-hoc reporting available

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Quality Customer Service

• Customer Service Representatives have quick
  access to Claim Processors
• Immediate issue resolution
• No Automated Attendant or Voice Mail
• System Provides Quick Access to Historical Claims
• Correspondence Phone Calls are Logged for
  Recall Follow-up
• Ability to record calls
• Silent Monitoring for Quality Assurance
• Express Requests via Internet
• Replace lost ID cards
• Check status of claims
• Verify eligibility

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Service Standards

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Internet Features

• For Employees Eligibility, benefits, claims
  status, PPO provider look-up
• Access to Plan Doc and Schedule of Benefits
• Health Wellness information
• Employer Access to all employee information
• Designated individual able to view HIPAA
  protected Personal Health Information (PHI)
• Easy access to Monthly Reports
• Employers May Perform all Eligibility Functions
  Across a Secure Connection
• Links to
• PPO Network
• Rx Vendor

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Risk Management

• Reinsurance
• A rated carriers
• Establish program protecting clients against
  catastrophic claims and unpredictable losses
• Package data to maximize insurer response and
  competitiveness
• Effective Utilization Review
• Pre-Auth, Concurrent Review, Discharge Planning
• Case Management
• Early notification via claims system and Rx data

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Ongoing Analysis

• Monthly Client Reporting
• Summary of Monthly Paid Claims
• Aggregate Report
• 50 of Specific Report
• Benefit Utilization
• Census
• Check Registers
• Meaningful reports that assist in assessing and
  managing risk and plan effectiveness

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More Than Third Party Administration

• Risk analysis
• Ongoing analysis of claims and reinsurance
  contracts
• Ongoing analysis of effectiveness of PPO and
  Utilization Management programs
• Program design consulting
• Ensure compliance with State and Federal
  regulations

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Administrative Services

• Comprehensive Administrative Services
• Perform all Billing and Collecting
• Conduct a thorough and comprehensive enrollment
  of eligible members
• Transfer eligibility to Pharmacy Benefit Manager
  and other partners
• Facilitate preparation of Plan Document
• Provide member and dependent identification cards
• Verify eligibility and benefits to providers
• Examine Claims
• Verify eligibility of Claimant
• Process claims in accordance with the Plan
  Document
• Coordinate Claims Processing with Utilization
  Review and Case Management partners
• Prepare an Explanation of Benefits (EOB) form for
  each claim submitted
• Handle member and provider claim inquiries
• Provide monthly management information to the
  Plan Sponsor
• Provide benefit design service and analysis of
  current benefit programs
• Full COBRA Administration
• Submission of all claims to reinsurer for
  reimbursement
• Provide information for required reports to
  governmental agencies,
• i.e., 5500, 1099

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Other Products Offered

• Guaranteed Issue Health Plans
• Critical Care Policies
• Long Term Care Policies
• Guaranteed Issue Life Insurance

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• AMERICAN GROUP ADMINISTRATORS
• Your partner in controlling health care costs
  while providing value added programs and superior
  customer service to your employees