The Orange County Foundation for Medical Care offers a wide variety of Administration Services to clients of all sizes. Most importantly we are built to be flexible to the individual needs of our clients by offering personalized services. There is no “one size fits all” plan, rather every plan is driven and tailored towards the aspects that best suit the individual needs of each group plan.
| Our list of administration services include: |
- Medical, Dental, Vision and Rx Claims Administration
- Flex Plan Administration (Section 125)
- COBRA/HIPPA Administration
- Retiree Administrative Services
- Educational Assistance Reimbursement Programs
- Carve Out Plans
- Premium Billings
- Employee Communications / Benefits Statements
- Electronic Claims Processing
- Re-insurance Filing
- Vendor Interfacing
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- Provider Network Access
- Repricing
- Out of Network Negotiations
- Fund Account Management
- Financial Reporting
- Encounter Data
- Subrogation
- Fraud Abuse & Detection
- Internal Auditing
- Plan Design Creation / Preparation
- Booklet Printing
- ID Cards and Forms
- Customer Service Call Center
|
Online Capabilities
The OCFMC offers online access to Employees, Employers and Brokers so all may have access to the claims information 24 hours a day, 7 days a week. Your employees will be able to log in to search and view claims, eligibility, accumulators, EOB’s and much more. In addition, we are able to offer online enrollment and give authority to the Employers to manage the rules and request.
Claims System
We partner with El Dorado computing and utilize the Healthpac system for all of our claims adjudication, plan and group management. This system undergoes continuous improvement by El Dorado systems to keep pace with changes in the healthcare landscape. Recent upgrades include the support for all standard forms of electronic eligibility and claims. In addition El Dorado systems recently rolled out comprehensive tools for the management of the Mandatory Section 111 reporting requirement.
Reporting Excellence
The reporting function for employer benefit plans has always been essential, however at OCFMC we believe the reporting function should not only be a statement of the past, but also a forecast for what is needed for future improvement. This is why we employ the JackRabbit Reporting system from MphasiS Healthcare Solutions. Currently we have over 130 ready to run reports along with the ability to run ad hoc reports to meet the needs of sophisticated client-centric reporting requests.
Predictive modeling capabilities
Our predictive modeling is driven by diagnosis and total costs. We have the reporting capability to determine the diagnoses that are most commonly associated with high cost of care. We correlate those diagnoses with a reporting feature called a Trigger Report that identifies when a patient receives one of the identified high cost diagnosis. With this method we can predict estimated short term costs for the client. |
