Health Plans

Schaller Anderson administers various health plans throughout the United States. For all the health plans we administer, we offer:

• Medical management, including disease, case and pharmacy management, prior authorization, concurrent reviews, monitoring of clinical quality indicators, predictive modeling, provider profiles, and prevention programs
  
  
• Administration, including senior leadership and management of plan operations
  
• Claims processing, including medical and pharmacy benefits, auto and manual adjudication of both paper and EDI claims, internal quality review of claims, external requests for additional information (self-funded only), reinsurance filing (self-funded only), claims inquiry/research, and encounter data transfer
  
  
• Member services, available around the clock, including member inquiries, checkup and inoculation reminder cards, initial and ongoing wellness education, assistance with appointment scheduling, member handbook development and distribution, and member surveys
  
  
• Provider services, including provider contracting and network development and management, provider education, immediate eligibility determination, and claims inquiry and research
  
  
• Financial reporting and analysis, including budgeting, forecasting, financial performance, operational service performance, utilization of health resources, and medical services provided
  
  
• Information technology implementation, including a 24-hour data center, electronic data interchange, network and database administration, advanced telecommunications systems, and management reporting
  
  
• Compliance management, including oversight of HEDIS, HIPAA, contracts, policies and governing regulations
  
  
• Actuarial services, including trend analysis, reserve development and budget projections, as well as development and evaluation of underwriting and rate setting by projecting historical claims and administrative experience to reflect trends, benefit changes and population shifts