Third Party Claim Administration

Self-Funded Medical, Dental and Vision Claims Administration
Customer Service
Quality Assurance  
Subrogation Administration  
Eligibility and Billing Administration  
COBRA Coverage Continuation Administration  
HIPAA Administration  
Short Term Disability Claims Administation  
Cafeteria Plan Administration, Health Flexible Spending and Daycare Accounts  
Health Reimbursement Health Administration  
Health Savings Account Administration  
Consulting Services  
Employer/Employee Direct Access

 

Contact us for more information.

 

Self-Funded Medical, Dental and Vision Claims Administration

Fox/Everett has highly trained claims analysts assigned to each account to provide the highest quality of claims administration service to our clients and their employees.

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Customer Service

Achieve client satisfaction of at least 90% Achieve participant satisfaction of at least 85%Achieve provider satisfaction of at least 80%Maintain average hold time of less than 60 seconds and abandon rate of 5% or less

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Quality Assurance

Fox/Everett maintains a quality assurance program for Claims, Customer Service and Enrollment featuring the following:

  • Comprehensive QA on transactions processed by new employees
  • Random QA of day-to-day transactions performed in claims office
  • Detailed review of 100% of adjustments and appeal "reversals" to determine if those transactions resulted from procedural or financial errors
  • "Focused" QA programs related to new clients and/or specific benefits/plans

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Subrogation Administration

Fox/Everett focuses on early intervention to achieve recovery success for our clients on claims that are the responsibility of a third party.

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Eligibility and Billing Administration

Fox/Everett performs eligibility and premium administration for our self-funded clients including monthly billing statements and eligibility listings. Our eligibility system tracks all date sensitive changes in eligibility and coverage and is integrated with claim processing.

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COBRA Coverage Continuation Administration

Fox/Everett offers complete COBRA administration services. These services include: 

  • Providing initial COBRA notices to all covered employees and spouses 
  • Generate notice of COBRA continuation right to terminated participants within 5 working days of date termination is processed 
  • Process ongoing COBRA premium payments and return premium to Plan Sponsor 
  • Notify COBRA beneficiary of termination of COBRA coverage and provide HIPAA certificate

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HIPAA Administration

Fox/Everett works with each client to accomplish the fulfillment of their continuing obligations set forth by the Health Insurance Portability and Accountability Act of 1996. Services include: 

  • Providing a HIPAA Privacy and Security Manual
  • Training and Consultation 
  • Drafting Privacy Notices 
  • Handling Business Associate Agreements
  • Distributing Certificate of Creditable Coverage 
  • Assist new enrollees in obtaining HIPAA Certificates from prior Plans

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Short Term Disability Claims Administration

Fox/Everett provides administration services for self-funded disability or loss of time plans.

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Cafeteria Plan Administration Health Flexible Spending Accounts and Dependent Daycare Accounts

Administration services include system interface with medical, pharmacy, dental and vision plans to allow automatic filing and payment of employees' eligible out of pocket expenses when Fox/Everett administers these plans for our client. Fox/Everett will consult and assist with the development of our plan design and your plan document. We will assist with employee education meetings and enrollments.

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Health Reimbursement Account Administration

Administration services include system interface with medical, pharmacy, dental and vision plans to allow automatic filing and payment of employees' eligible out of pocket expenses when Fox/Everett administers these plans for our client. Fox/Everett will consult and assist with the development of your plan design and your plan document.  We will assist with employee meetings and enrollments.

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Health Savings Account Administration

Administration services include system interface with medical, pharmacy, dental and vision plans to allow automatic filing and payment of employees' eligible out of pocket expenses when Fox/Everett administers these plans for our client. Fox/Everett will consult and assist with employee education meetings and enrollments. Fox/Everett has an arrangement with an IRS approved custodial bank for HSA's. Fox/Everett will manage an HSA owner's qualified expense inventory; we will prepare required IRS Form 8889 for each HSA owner.All HSA accounts are web enabled for the owner to view balances of both HSA and the inventory of the qualified expenses. Withdrawal requests can be made via the web and withdrawals will be direct deposited into the HSA owner's personal checking account or savings account.

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Consulting Services

  • Stop Loss Placement    
  • Plan Design    
  • Cost Projections     
  • Management Reporting

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Employer/Employee Direct Access

Fox/Everett's clients and their employees have web access to eligibility and claims data as well as the ability to conduct eligibility transactions. Eligibility, claim and benefit information is real time and the information is available 24 hours a day, 7 days a week. All information is secure and HIPAA compliant.

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