Health Plan Management

When you select AmeriHealth Administrators, you optimize your health benefits investment. We help you preserve the value of your benefits investment and manage costs with an integrated approach to benefits asset management: health plan de­sign + network discounts + claims management + health management + client service = high-value asset management.

With a foundation built on over 70 years’ experience in health benefits management, we deliver a unique array of capabilities.

Integrated, Focused Approach to Health Benefits Management

• Nationwide network with local-network strength is based on in-depth accessibility studies and ongoing reviews of network options to ensure the best network access for your plan members wherever they live or travel in the U.S.
• Health management programs provide compassionate care management to ensure services that are medically necessary, support members’ health care decisions and treatment compliance, promote healthy lifestyles, and identify and manage chronic conditions.
• Stop-loss services for placement protect your risk — through established relationships with A-rated carriers — and administration of aggregate and specific coverages.
• Actuarial and underwriting services provide comprehensive reporting of plan performance, evaluate plan design options and cost implications, monitor deposit and reserve requirements, monitor network utilization, and identify risks through predictive modeling.
• Member support services offer centralized, knowledgeable customer service call center teams; pre- and post-enrollment communications services; and online tools and resources.
• Funding administration and reporting provide weekly and monthly recaps of benefits disbursements, deposit maintenance, and coordination of transactions with third party vendors, stop-loss MGUs, and carriers.
• Technology-driven eligibility and claims management ensure efficient operations and support electronic data interchange (EDI), automated adjudication, paperless claims processing, stop-loss, coordination of benefits, subrogation, and appeals.
• Performance monitoring and reporting ensures compliance with your service-level expectations and our high standards.

Network Advantages — local network strength, nationwide:

• AmeriHealth Administrators extensive proprietary network;
• network relationships with over 50 regional and national managed care networks in the U.S.;
• ensure access for your plan members and value for your plan;
• nationwide travel network;
• access for your plan members when they travel or for dependents who study away from home, across the U.S.;
• network management services include:
  • Centers of Excellence network;
  • network performance reporting;
  • seamless networks and claims processing integrity.

Our underlying proprietary technology enables a high degree of control as well as flexibility, scalability, and responsiveness to meet each client’s unique needs and to leverage capabilities across our customer base. We select our third-party solutions after thorough evaluation to ensure operational efficiencies, controls, and integration with our technology infrastructure.

Through AmeriHealth Administrators, clients experience a continuous 360° approach to help you plan, manage, and assess your health benefits program.