Whether you require state-of-the-art claims adjudication services, panels of prestigious contract providers or a comprehensive array of utilization management services, HS1 offers integrated care management solutions.

In the past, many Payors were forced to contract with multiple, unrelated third-party vendors in an effort to piece together an effective managed care program.  HS1 proudly offers its clients an unparalleled portfolio of integrated care management systems and services that are rarely, if ever, found under one roof. 

HS1 Administrative Services Include:

• Fully-licensed Third Party Administrator (TPA) for adjudication of Medical, Dental, Vision, Behavioral  and Ancillary claims

• Benefits & Eligibility Management

• Provider Demographic and Fee Schedule Maintenance

• Capitation and FFS Claims Payment or Repricing

• Member Services

• Regulatory Compliance & Government Relations

Benefits Design:

HS1 can assist in the development of Benefit Plan Designs which promote quality, cost-efficient care.

A wide array of Network and Reimbursement Models are available:

• PPO / EPO / Indemnity Programs

• Point-of-Service / Multiple Option Plans

• Gatekeeper / Capitatation Models

• Negotiated Fee-for-Service Arrangements

Financial Recoveries:

• Third-party recoveries including Stop-loss, Subrogation and COB

• Retrospective contestation of incorrect payments by health plans

• Over 20 proprietary screens for evaluating accuracy in claims adjudication

• Hospital and Physician claims auditing