NAA processes medical, prescription, dental, vision, Flex, and disability claims using a fully HIPAA-compliant, automated benefit management system which is completely integrated with both billing and eligibility systems. This state-of-the art, real-time system provides instant claim and eligibility information as well as exceptionally efficient claims and encounter processing of even the most complex transactions.
Our claims system, LuminX (by Ebix), is customized to meet our specifications. All plan-specific parameters, usual and customary data, provider data, and PPO repricing data are maintained in our system as a component of the claims auto-adjudication process. Numerous built-in controls are included within this system, such as those that detect erroneous or invalid charges, identify claims for potential case-management involvement, require network repricing or non-network negotiation, and other cost-saving plan features.
Our quick turnaround and accuracy rank among the best in the industry. Yet, while timeliness is critical, quality is the hallmark of our reputation. We have an aggressive quality assurance program for auditing claims before payment is made to confirm eligibility and accuracy, assuring that over 99% of our processed claims are valid. Our Quarterly Quality Assurance Report provides a summary of our performance.
Click on the image to see a sample of an EOB and then click again when you see the magnifying glass to clarify the page.
Other Quality Controls
New plans undergo 100% claims auditing for the first 30 days after implementation to insure proper plan building and employee training are completed.
Mandatory audits are conducted on all claims that exceed specified high-dollar limits.
Subrogation and Coordination of Benefits are aggressively pursued to determine other carrier or other plan liability. In most instances, we are able to obtain 100% recovery without incurring the cost associated with outsourcing these duties. These services are included in our standard administration fee.
NAA has the resources available to administer these programs.
Electronic Funds Transfer (EFT)
EFT is available as requested for quicker, more efficient participant and provider payment.