Self- Funded Benefit Claims Adjudication and Payment

The costs associated with Employer Health & Welfare Programs are critically important to every Plan’s bottom line, yet identifying and controlling these costs can be very difficult. One key to effective cost control is your ability to make strategic decisions about Benefit Plans. To assist in this regard, Phoenix Benefit Administrators, Inc. provides a variety of summary and detailed management reports, which keep the client posted on how plan dollars are being spent.

At Phoenix Benefit Administrators, LLC, the same staff members who work on the client’s account are directly available to answer both management and member questions, and can provide efficient resolution of problem claims. Whether they choose telephone, postal mail, secure internet, or a personal visit as the method of communication, there is no question that our courteous, accurate and efficient service is an ongoing boost to Member morale.

Key tests used to evaluate claims to achieve maximum cost savings:

• Claimant Eligibility – Is the Employee, Retiree or dependent filing the claim entitled to benefits?
• Eligibility of Expenses – To what extent are the incurred expenses covered by the Plan?
• Reasonable and Customary Charges – Is there a maximum benefit for this type of claim?
• Coordination of Benefits and Subrogation – Do other benefit Plans lessen the Union health care plan liability?
• Calculation of Benefits -Considering the above questions, what is the benefit amount to be paid?

Services provided:

• PPO Coordination/Payment
• 1099/1096 Tax Forms preparation, mailing and filing
• W-9 Reporting/Compliance
• FICA (SUTA) Withholding/ Depository/Filing