• Policy Issue, fulfilment and services
• Online Quoting and Enrollment – using your or our tools/technology
• Online or paper Policy Fulfilment including ID Cards, Certs, forms
• Inforce policy changes on-line or via Call Center Full policy renewal support
• Fully integrated, end2end platform

• EDI Claim input
• 100% batch adjudication; Highly Customizable Auto Release *Parameters by group, product
• Comprehensive System edits; Eligibility, Provider, PPO, Coding
• EDI interchange with PPO and Cost Containment Vendors
• Automatic Application of Late Claim Interest and Penalty amounts Configurable by State
• Flexible Audit Configuration; Silent and $ amount
• Carrier approval for high dollar claims
• Experts at managing claim cost for risk takers
• Special Investigation Unit for claims Fraud, Waste and Abuse
• Cost Containment programs including Claim Edit, Bill review, Clinical review, OON negotiations
• Members of NHCAA

• Customizable EOB templates
• State Mandated EOB language
• Integrated with a number of fulfilment vendors
• CAQH CORE® certified
• Check or EFT
• Paper or Electronic EOBs

• Capable of reporting Single Agent as well as Complex hierarchal arrangements (10+ levels)
• Earned and Advanced commission models
• Advance Balance Monitoring of Agent debt to ensure an appropriate debt ratio is maintained
• Efficient recovery of Advance payments
• Flexible commission payment schedule
• Consolidated commission payment for all products by EFT or Check
• Detailed Commission Statement available in pdf and Excel compatible formats
• Timely processing of Commission inquiries and requests

• Appeals loaded into workflow
• Acknowledgement letter sent
• Response Management Systems
• Application of State Specific requirements
• Close Case Systemes

• All calls are recorded
• Quality Management systems applied: randomly audit incoming calls for quality
• Provider Questions: Claim Status and Verification Of Benefit
• Employer Questions: Invoice/Billing, Payment and Eligibility
• Employee Questions: Claim Status, Benefit Questions, ID Cards, Plan Documents and Payments
• Learning and Development programs
• Six Sigma Methodologies applied

• Billing, Collections, Premium Accounting
• Individual and Group billing using multiple methods and frequencies
• Consolidated Billing-Multiple policies, one deduction via credit card or ach
• Add/update credit card or ach information via online portal or via telephone call to our Call Center
• Update credit card expiration dates via online portal or via telephone call to our Call Center

• Key Performance Indicators developed based on Client Requirements
• Claims expectations: Turn-Around Time – 90% within 10 Days
• Financial Accuracy – 99.5%
• Procedural Accuracy – 99%
• Call Center expectations:

  Average Speed to Answer – 120 Seconds

  Abandonment Rate - < 5%

• Policy Administration expectations: Issue Turn around Time – 48 hours

EHAE oversees thousands of dedicated healthcare advocates that ensure your patients receive the care they deserve while reducing your overall costs. That’s why more than 400 healthcare providers trust EHAE to develop and deploy custom solutions that grow top line revenues, control expenses and provide an insanely great patient experience.

EHAE holds our support teams for our Carrier Partner operations to the same high standards required to service members with complete, memorable experiences. EHAE offers scalable staffing from one of top, most mature healthcare footprints in the industry. We use proven data-driven insights to match member preferences with the best fitting products and services, while always giving attention to the prevention and improvements needed to make the healthcare experience accurate and compliance oriented.

We help employees, as consumers of healthcare, make informed decisions about their care based on both cost and quality.

At EHAE, we strive to ensure employees receive the right care, in the right place, at the right time. The effective partnership that we establish between our employer customers, healthcare providers, pharmacies and the overall management platform is ultimately designed to benefit the patient.

By managing the direct cost of healthcare in an always-increasing cost environment, your employer can better provide affordable healthcare benefits, while assuring the best care is available through our highly coordinated network of hospitals, clinics and physicians.

We also give you the opportunity to be a part of a system that prioritizes the overall health of each employee and family.

Through our network of trusted advisors, we enable Brokers the support and technology needed to be successful in supporting small and medium sized businesses. We bring easy access to affordable, quality workforce products, technologies and services

With our selection of Group, Individual and Voluntary products, we have a solution to fit every client’s needs and budget.

For Medical insurance needs we offer support for: Fully Insured Group, Medicare, Stand Alone Healthy Incentive Programs Minimum Essential Group, Individual Major Medical, Short Term Medical and non-insurance related products.

Supporting Ancillary needs EHAE offers Dental and Vision options such as: Employer Sponsored Group Dental / Vision, Voluntary Group Dental / Vision, PPO and Indemnity and Individual Dental / Vision.

To complete benefits offerings EHAE provides products and support for Ancillary products as well. We offer Group Life (Employer Sponsored / Voluntary), Group Disability (Employer Sponsored / Voluntary), Critical Illness (Employer Sponsored / Voluntary), Cancer (Employer Sponsored / Voluntary) and others.

EHAE currently provides membership support to a number of associations. This includes membership retention, attraction activities, and events. We have successfully assisted dozens of organizations to stabilize and grow their membership. We provide an outstanding level of service and support to members; maintain accurate and current databases; and manage timely and effective communications with members and boards of directors. EHAE has developed several strategies for recruiting new/younger members, such as the use of social media to reach and engage new members.

An effective association management partnership is based on an understanding of the goals, objectives, operating style and interests of the organization. To ensure a sound understanding of the requirements of your organization, EHAE will work with your leadership to learn as much as possible about your organization, its mission, members, goals, objectives and accomplishments.

EHAE has established the policies and procedures to successfully manage associations throughout North America. We have continuously explored new ways to utilize technology to enhance and upgrade our organizational operations. Our professional staff is well trained to provide quality service to your membership and Board of Directors.

We align providers with employers to strategically improve the health of the community.

EHAE serves as a neutral party, facilitator and infrastructure system that supports working relationships between healthcare providers and employers. This allows healthcare providers working through EHAE to focus on keeping the needs of their patients at the top of their priority list.

EHAE partners with the leading healthcare providers in our service regions. We work closely with each partner to steer patients from our employer customers, and do so using equitable reimbursement methods that reward the quality and accessibility of care along with cost management. In doing so, EHAE provides access to key utilization and spending metrics that allow hospitals and clinics to clearly understand the business relationship with key employers in their service areas.

Through the employer relationships and access to key metrics, healthcare providers working with EHAE are enabled to effect change within a population of patients. This allows for better, more effective care for patients, improved financial performance and a better overall delivery process.

As healthcare reform continues to reshape the industry, EHAE has kept up by continually supporting healthcare BPO clients as they try to lower costs and deliver exceptional BPO support for member servicing.

Our flexible solutions can ramp up as demand increases, while data and analytics help us identify and eliminate pain points. Thanks to our HIPAA and PCI-compliant solutions and customer-centric focus, you can rely on EHAE to keep you and your members in great hands.

EHAE offers revenue enhancing systems and strategies through data-driven insights that match member preferences with products and services they are most likely to purchase and retain. EHAE is an industry leader in preventing, detecting and correcting healthcare compliance issues, while providing client alternatives to meet the cyclical needs of the season with burstable staffing modeling for seasonal enrollment needs and across multiple locations.

The EbixEnterprise CRM helps you manage your sales and marketing lifecycle from prospect to customer. Built specifically for the Insurance and Financial industries, this Agency Management tool is used by over 300,000 Insurance & Financial Advisors.

• Anywhere: Responsive web design for mobile, tablet or desktop
• Adoption: Integration with Outlook means you need only one place to maintain contacts, appointments and correspondence
• SmartPad: Keeps all of your notes, messages and correspondence in one convenient place
• Integration: With Ebix HIX Marketplace along with thousands of Insurance and financial web based solutions
• Customizable User Experience: Whether you’re in marketing, sales or management, you can create customized dashboards that are easy to design, easy to use and provide you with instant access to data
• Agency Management System (AMS): Our industry leading AMS is scalable from small agency to enterprise level management

The Benefit Exchange Hub allows you to shop, quote and enroll in Association, Group and Individual health plans. When you utilize the automated workflows between consumers, agents, and carriers, you can consolidate billing and commissions platforms.

• Association health plan, group and individual flexible platform: This platform is configurable for multi-product – multi plan offerings in support of associations, organizations, carriers and individual health insurance needs
• Shop, Quote & Enroll: Provides a Health Insurance Hub for Carrier’s products or Multi-Carrier exchange
• Customized: Screens and forms can be white labeled with Carrier format/branding
• Workflows: Consistent and steady communication between broker, consumer, employer and carrier
• Integration: Information from the prospective consumer or employer seamlessly moves from the CRM to the Exchange to Policy

The EbixEnterprise Portal provides real time access to benefit and claim information, and to dozens of HR, benefit and wellness solution integrations.

• Progressive & Customizable: SharePoint technology
• Flexible: Integrates easily with other portal solutions
• Employee Communication: HR Setup through EE tools
• Enrollment: Complete & complex benefit
• Claim, EOB, FSA, Billing: From benefits admin platform
• Total Rewards: Printed or online
• Health/Wellness Promo Pieces: Printed or online
• Interactive Health/Wellness: Award winning content
• Ask A Doctor: Ebix or Private MD network
• Partner Solutions: HR360, Health Bluebook, etc.

The Policy Administrator is a robust policy administration and contract management solution that provides automated delivery of all documentation and allows comprehensive carrier/administrator financial management – including general ledger, bill, pay and commission.

• System of Record: Financial – GL, A/R, A/P, commission, products, plans & rates, organizations and subscribers
• Policy Workflows: New, Amend. Renew, Cancel Back dated amendments Riders – one source for rates, policy documents, premium, and claims payment
• Contract Management: Microsoft Word templates, policy, SOB, ID card, letters, etc., Automatic versioning and library, User defined triggers for automation
• Cash Management: Bill and pay premium, EFT/ACH/deposits
• Carrier Accounting/Reporting: Complex carrier reports, Quota Share, All standard GL reports

The Claims Administrator helps you manage the claim lifecycle, as well as all variations of health insurance, customer service and reporting.

• Comprehensive Solution: Manage the entire process – claim workflow, auditing, stop loss, medical management, payment and reporting
• High Speed & Scalable: Technology built for large databases with instant response times
• Claim Workflow: Capture imaging or EDI, adjudicate automatic or manual, electronic routing, cost containment – PPOS, clinical editing, fraud, COB, etc.
• Customer Service: Notes, documents, claims, EOBs in one place, IVR and Portal for self-service

EbixEnterprise Analytics allows you to produce complex reports in minutes. You can also utilize the interactive business intelligence suite to export your data in hundreds of different formats.

• Data Warehouse: ETL - Claim & Policy information transformed to Oracle warehouse structure
• Cognos Web Reporting: Design studio tools, automate, schedule & distribute, real-time portal with drill-down
• Cognos Business Intelligence: Real time data analytics, calculate, slice information, create reports & Graphs
• Data Integration Studio: Map information in/out of EbixEnterprise, automated processes to move information