ASO core offerings Self-funded groups, sized 51 99
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Regence ASO core offerings Under an ASO self-funded arrangement, you define the ideal balance between control and risk. With Regence ASO, you can rely on professional eligibility and claims administration, along with high-quality clinical services and a solid provider network that offers savings through deep discounts. The following products and services are available as Regence ASO core offerings. Benefits, simplified We ve made it easier to enroll in and administer your Regence benefits. We offer two solutions for enrollment and eligibility information transfer that make doing business with us faster and easier. You can choose the one that best meets your needs. What you re looking for Digital Basic (electronic eligibility) Digital Enhanced (online eligibility) No additional cost to your organization Reporting HSA integration with HealthEquity Online access for employees Decision support during benefit election Online messaging tailored to employees Suite of educational tools More than one medical plan offered Online customer technical support Digital Basic An offering for groups with electronic eligibility capabilities (including ANSI 834 and simple file format) Digital Enhanced A robust, web-based benefits management tool that allows members to update their own information for reduced HR burden Regence receives an administrative fee for each HealthEquity Integrated HSA. The fee allows for a high level of support and integration between Regence s health plans and HealthEquity health savings accounts. HealthEquity is a separate and independent company that does not provide Blue Cross and Blue Shield products or services, and is solely responsible for its products or services. 3
Clinical services Utilization management This is more than simply a program used to drive down costs. Instead, activities are the key to ensuring members receive quality, evidence-based, cost-effective care that aligns with our guiding principle, the Triple Aim: improving the member experience, improving member health and lowering health care costs. Medical policies and pre-authorization: Our pre-authorization list is based on our medical policies, which are among the most comprehensive and respected in the industry. In fact, they are adopted by many Blue Plans, as well as by the federal government, confirming the strong results our program delivers. Clinical review and reimbursement: We ve created an industry-leading proprietary process to manage costs associated with care provided in an acute inpatient facility. High-risk claims are reviewed by our team of registered nurse auditors, coders and pharmacy technicians, who perform up to 14 different clinical and non-clinical prepayment reviews for each claim, resulting in significant savings. Optional utilization management programs: We offer several optional utilization management programs in addition to our standard preauthorization program. Optional programs ensure medical necessity of specific services known for being at high risk for quality problems or inappropriate utilization. These include physical medicine, advanced imaging authorization and sleep medicine programs. Care management Care management delivers a personalized model that focuses on holistic care and collaboration with doctors. This model provides a single care manager for members with the greatest unmet health care needs, with the goal of achieving the best outcomes possible. Medical and behavioral health issues are not separate from each other, so our integrated model connects members with a clinician best trained to support their primary concern, with a team of registered nurses and social work case managers available for further support. Palliative care: Regence is nationally recognized as an industry leader in improving the care and quality of life for members facing serious and endof-life conditions. The program provides members, their families and caregivers, and their doctors with support and solutions. Optional care management programs: These programs provide additional support to members with specific chronic diseases, expectant mothers, members looking to quit tobacco, and any member looking for 24-hour medical advice. Additional medical management, and health and productivity services are available at additional costs. Please see ASO optional program offerings for an overview of programs dedicated to advanced imaging, disease and pain management, and sleep medicine. Utilization management processes comply with turnaround times required by state and federal regulations. We are accredited by the National Committee for Quality Assurance (NCQA) and follow NCQA standards. Our goal: to connect employees with the right care at the right time, and to empower them to return to health as quickly as possible. 4
Use our Live Chat feature Monday through Friday between 7 a.m. and 5 p.m. Customer Service Customer Service is available Monday through Friday between 5 a.m. and 8 p.m. and Saturday between 8 a.m. and 4:30 p.m. (Pacific time). Your dedicated Customer Service Department has a toll-free number and calls will be answered by one of our customer service professionals. Our Voice Response Unit is available 24/7; employees can check claim status, request claim forms, order member ID cards and hear benefit information at any time. Benefit coordinators have direct phone and email access to dedicated team leads. Our secure member web portal provides benefit information and allows your employees to: Order or print member ID cards View claims status and print explanation of benefits (EOB) documents Review eligibility and check authorization status Submit other health insurance questionnaires Email Customer Service Access provider cost and quality information, a personal health record, online provider directory, a wellness library, their prescription drug history, and details about pharmacy benefits Claims Dedicated teams process claims in our ServiceHub in Burlington, Washington. Team structure Each claims team is led by a supervisor and includes an operations lead and several claims analysts. The claims analyst team has an average tenure of more than 10 years. Analysts and supervisors have been specifically trained to serve our self-funded accounts. In addition to being on site at the Burlington ServiceHub, team members are able to work from secured environments in their homes. This popular program increases productivity and enables teams to adjust work hours based on claims volume. Home-based workers productivity isn t affected when inclement weather forces our offices to close. Training and auditing Our six-week new-hire training program provides claims trainees with the system and processing knowledge they need to process medical, hospital and vision claims. Trainers review all trainee claims before releasing the trainee to the Claims unit. The unit reviews claims for accuracy for the first two weeks; after that, the new employee goes through the Quality Assurance and Reporting area s monthly audit process. Claims are audited regularly by our Quality Audit Department to ensure processing and financial accuracy. Quality improvement activities are ongoing. 5
Underwriting Services included Stop loss integrated quotation Calculation of COBRA rates Claims projections Cost/benefit analysis of plan design 50% of specific stop loss level reports Audit of stop loss claim above specific level Custom claims invoice options (available by request) ERISA Form 5500 services Schedule A and C filings Billing file format options Online administrative fee billing is available through our secure website. We create invoices in both PDF and Excel. You may elect to receive only the PDF, or both the PDF and Excel versions. You can choose to receive a hard copy in the mail or have that hard copy suppressed. Billing level details We offer you a choice of three statement options with varying levels of detail. Information included Option 1 short statement Option 2 subgroup summary Option 3 class summary Claims activity and fees Included Included Included Claims per billing and subgroup Included Included Claims per employee class Included Claims per benefit plan Included Included Detailed claims per member Weekly claims invoicing Oregon groups: All claims paid from Wednesday through Tuesday are included in the invoice that generates the following Wednesday. The invoice is available for delivery by email each Thursday. Washington groups: All claims paid from Saturday through Friday are included in the invoice that generates the following Saturday. The invoice is available for delivery by email each Monday. 6
Reporting Services included Our online Employer-Based Reporting (EBR) system provides reporting for claims and utilization data. EBR training is available for groups and producers. Employer Center is our online employer access point. It allows you to: Get instant access to eligibility information Access claims and eligibility summary data Additional reporting is available: See your population s participation in medical management programs Custom reporting is available for an additional cost. Please ask your Regence sales executive for more information about what we offer. Pharmacy Services included Fully integrated pharmacy services Real-time pharmacy claims processing integrated with the medical plan; no separate eligibility feed required Pharmacy data incorporated into online reporting system A single member ID card, with one customer service number and a single website for both medical and pharmacy benefits Pharmacy Services has several programs that offer valuable information, cost savings and new ways to manage prescription dollars. Programs include: Blood Glucose Meter Program Specialty Drug Program Half-Tablet Program Information on other patient assistance programs Site of Care Program Network advantage BlueCard Program advantage BlueCard gives your employees seamless access to physicians and hospitals that participate in Blue Plan networks across the country. The program links these providers with all the independent Blue BLUE PLAN NETWORK NATIONWIDE PARTICIPATION: 96% of all hospitals 92% of all doctors Cross and/or Blue Shield Plans through a single electronic network for claims processing and reimbursement. So no matter where they live, work or travel, your employees will be covered at your plan s benefit levels. Blue Cross Blue Shield Global Core is a medical assistance program that connects employees traveling or living outside the United States, Puerto Rico and the U.S. Virgin Islands to a network of more than 9,000 hospitals and 21,000 health care professionals and outpatient care centers around the world. The program also provides claims support, referrals to providers, translation services and medical monitoring 24 hours a day, 365 days a year. It may provide other services, such as medical evacuation coordination, depending on your plan benefits and our payment guarantee. Regence preferred network Regence is local, has a long history of doing business in our communities, and brings a high volume of business to our network. This volume drives deeper discounts, and employers can rest assured that our providers are dedicated to caring for their employees. Our traditional Regence preferred network provides discounted access to care almost anywhere, which is crucial for international companies and those with employees who travel or work in rural locations. 7
We re here to help you choose the programs that are right for your employees needs. For more information, please contact your producer or Regence Sales. Regence BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association Regence BlueCross BlueShield of Oregon 100 SW Market Street Portland, OR 97201 REG-149103-18/09-OR-rep149103-17 2018 Regence BlueCross BlueShield of Oregon Regence complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-344-6347 (TTY: 711). 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 1-888-344-6347 (TTY: 711).