provided by PHP Management Systems, Inc.

Exceptional Service. Industry Expertise. Medical Cost Savings Focused

As the third party administrator for your health plan, our service vision and goals are centered on listening to and taking care of your benefit needs. Our commitment to operational excellence is reflected in every service we provide from working with your employees to answer their benefit questions through medical cost-containment and savings programs that will offer a positive impact to your bottom line.

The following is an example of items and services that would be included in the per employee per month (PEPM) administrative fee when selecting a standard benefit package. General Administrative, Claims Administration, and Medical Cost Savings have been used to categorize the various items and services included.

General Administrative Services

• Enrollment Package
• ID Cards
• Standard Provider Network Directories
• Summary Plan Description (SPD)
• HIPAA Certificate
• Dedicated Account Manager
  - Actuarial (Benefits) Consulting
  - Annual Budget Estimates and Forecasting
  - Program Installation
• Benefit Orientation Sessions
• Call Center Services
• Walk-in Customer Service
• Web site Service:
  - Details about personal benefits
  - Request identification cards
  - Provider directory and geographic locator
  - Claims status
  - Eligibility data specific to each covered individual
  - Contact Customer Service
  - Health tips and preventive care information
  - Check for possible drug interactions
  - Order prescription drugs through Express Choice^SM
  

Claims Administration

• Claims Processing
• Standard Reporting
• Subrogation
• Coordination of Benefits
• Claims Review
• Claims Audit & Fraud Prevention Processes
• Explanation of Benefits
• Out-of-Network and Emergency Services, Claims Review and Price Negotiations

Medical Management / Cost Saving Programs

• Medical Management
• Utilization Management
• Disease Management Initiatives
• Case Management Reporting
• Wellness Initiatives