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NGS CoreSource Services
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Eligibility Administration
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The single most powerful cost containment management tool available to employer-plan sponsors today is effective eligibility administration. While NGS has promoted precise eligibility controls for years, the market has recently realized the value of the fundamental principle of monitoring and auditing plan enrollment data to ensure only entitled individuals are receiving benefits under the health plan. Difficulties in the collection and maintenance of this data have often made the power of this plan management tool go unnoticed or underutilized.
NGS CoreSource offers both EDI HIPAA compliant enrollment maintenance with daily updates or a web based application (WES - Web Eligibility System) that allows clients to manage eligibility information for their employees in real time. The NGS CoreSource eligibility system acts as a gatekeeper protecting your plan against fraud and other ineligible expenses.- Eligibility record changes, including COBRA events, become effective in real time after they are entered in the system. In other words, we provide you with the tools you need to adjust eligibility status at the precise moment an eligibility event occurs and we track all "pending" periods of coverage such as the COBRA waiting period and payment grace periods separately.
- Information necessary for proper administration is tracked through the eligibility system which is fully integrated with claim adjudication programs and fully historical. This means that claims are adjudicated in accordance with the specific plan, network and eligibility in effect at the time the service was obtained.
- Coordination of benefit (COB) records are maintained by family member, by plan type, and are also date sensitive. Additional COB information captured, including plan sponsor of the other plan, primary covered person of the other plan, divorce decree information, etc. This information is used to enforce your plan's secondary payment position at the point of claim. NGS' claim system actively determines primary/secondary status and prohibits primary payment where other primary coverage is in effect for the date of service.
- All eligibility information maintained in the NGS system can be electronically transmitted to other plan providers such as HMOs, PBMs, vision, dental, and EAP providers.
Dependent verification and full dependent audit services are available under which NGS enrollment and eligibility analysts review actual documentation of eligibility such as marriage licenses, birth certificates, divorce decrees, school accreditations, etc. Our dependent audits have resulted in reductions of 7 to 9 percent in the dependent population with return on investments between x and per dollar spent!
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Medical Claims Administration