IHS designs, implements and manages healthcare programs for employers self-fund their employee health benefit plans. We are a full-service administrator able to provide a complete and integrated package of services at one address--- a one-stop shop for customer service, claims management, medical services management, reporting and actuarial services and stop-loss insurance protection.
Group health benefits are of major importance to employees and a significant expense for employers. The insurance companies and HMOs who control access to healthcare and the cost of that healthcare have failed in many ways to meet the expectations of their clients. As frustation with cost and access mount, and service standards decline, smart employers are increasingly attracted to self-funding.
We understand the motivations and expectations of an employer who chooses self-funding. We have the professional expertise to identify risk, the resources to reduce risk, and the data to manage risk. We employ our own physicians and nurse case-managers and do our own quality assurance and care management.
Highlights of our Services
Management Information System
The EZCAP Management information System is a HIPAA compliant claims and information management system. Within the system are fully integrated modules for eligibility, claims adjudication, provider data, referrals and utilization review actions, customer service contact and HIPAA compliance, case management, data analysis and report writing. The ease with which it supports custom reports is outstanding.
Claims Management
Accuracy and timeliness of claims payment is at the core of risk management. We don’t tolerate a claims backlog - period. System edits for correct coding, procedural unbundling, etc., help to assure correct payment, but the foremost protection against error is properly trained staff. Our Claims Quality Assurance Program identifies training issues and performance problems quickly, and correct them immediately.
Large Case Management
Catastrophic claims or ongoing care for the chronically ill patient will be the largest single factor in plan costs. Unless it is well managed, it can be a huge drain on an employer’s benefits budget. Our Case Management Program is designed to assist our medical professionals to identify very costly or chronic situations and coordinate services and resources to avoid duplication and fragmentation. We support patient and family with regular telephone contact by a specially trained registered nurse. Our Case Management module is an excellent planning and forecasting tool to project future care needs, target opportunities for intervention and develop an appropriate budget.
Customer Service
At the core of our customer service philosophy is respect for our customers. We understand the sensitive and personal nature of our interactions with employees and their family members and our goal is to make every interaction with IHS pleasant, informative and helpful. More formally, we periodically survey our customers to ask them how we are doing. In response to a recent survey we will be providing greater access, through our web site, to health education and health awareness material, such as prescription drug usage and alternatives to higher-cost brand drugs, information about new treatment technologies and the latest in preventive care tips.
