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Premium Billing Services

At American TPA we understand Insurance & HealthCare Premium Billing very well. We also understand that you may have questions around which is the best software and which firm can provide both System & Services under one roof. Our recommendation is www.AmericanTPA.com – A Global Services firm with sweet spot into HealthCare Claims, Premium Billing & Contact Center. They work with Plexis HealthCare Systems to provide you 2-in-1 Platform BPO @ low PMPM pricing. The services will be delivered via Onshore (within America) by best in class professionals.
So how AMERICAN TPA (2-in-1) Solution is different?

Here is why?

  • AMERICAN TPA System & Services support the ability to calculate premiums using the following billing frequencies:   
    1. Annually                             
    2. Semiannually                    
    3. Quarterly                            
    4. Bimonthly                          
    5. Monthly                              
    6. Semimonthly                    
    7. Biweekly                             
    8. Weekly
  • AMERICAN TPA System & Services can calculate premiums using your active member roster                      
  • AMERICAN TPA System & Services retroactively adjusts premiums using retroactive member eligibility changes               
  • Its premium calculation methodology allows various proration methods for members who become eligible mid-billing period     
  • Proration methods can be defined differently per policy                              
  • AMERICAN TPA System & Services can support the following premium calculation methodologies:          
    1. Family tiers                        
    2. Age / gender tiers                          
    3. Flat rate per subscriber                
    4. Flat rate per dependent                              
    5. Custom rate per member                           
    6. Rate per unit (number of units defined per member)                    
    7. Life using assigned death benefit volume                            
    8. Life using salary-based death benefit volume                    
    9. Short term disability                      
    10. Long term disability                        
    11. Other premium calculation methodologies                         
  • AMERICAN TPA System & Services can support the ability to apply weightings / factors to a base premium amount
    1. The base premium amount be automatically increased or decreased depending on each member’s age, gender, medical condition, location of residence, etc.                    
  • AMERICAN TPA System & Services can integrate receipt of premium payment with claims adjudication
    1. It can Pend, hold, or deny claims automatically if a premium payment is not received within a defined period  
    2. It can support the release of all claims which were pended, held, or denied because of lack of premium payment, when premium payment is received                 
  • AMERICAN TPA System & Services can support the ability to assign a special result code to claims which were pended, held, or denied for lack of premium payment                  
  • AMERICAN TPA System & Services can support the ability to bill groups and subscribers for premiums                   
  • AMERICAN TPA System & Services can support the ability to change a premium rate without creating a new policy or eligibility                        
  • AMERICAN TPA System & Services can supply premium invoice and payment receipt history information viewable from the policy itself                     
  • AMERICAN TPA System & Services can support the ability to view all members which were included in a premium calculation                          
  • AMERICAN TPA Premium Billing System & Services can support the ability to view billed premium information from a member’s record?                      
  • AMERICAN TPA Premium Billing System & Services can support premium calculation methodology enable users to create an age reduction schedule (where for example, a life policy’s volume would decrease by x% after the member reaches age X)                               
  • AMERICAN TPA Premium Billing System & Services can support the ability for users to create custom family or age / gender tiers for use with premium billing                             
  • AMERICAN TPA Premium Billing System & Services support the ability to calculate premiums during non-production hours                   
  • AMERICAN TPA Premium Billing System & Services can support the ability to calculate premiums without locking the user’s session           
  • AMERICAN TPA Premium Billing System & Services can support the ability to calculate all active premiums / policies at one time                        
  • AMERICAN TPA Premium Billing System & Services can support the ability to make adjustments on a calculated premium after the premium has been calculated                             
  • AMERICAN TPA Premium Billing System & Services can support the ability to integrate with a GL system for tracking premiums invoiced                        
  • AMERICAN TPA Premium Billing System & Services can support the ability to transfer large batches of invoices to a GL system to automate the assignment of a document or invoice number           
  • AMERICAN TPA Premium Billing System & Services can support the ability to integrate with a GL system for entering / tracking premium receipts                     
  • AMERICAN TPA Premium Billing System & Services can support the ability to associate a debit / credit account from a GL system with a premium invoice                      
  • AMERICAN TPA Premium Billing System & Services can support the ability to track changes in member’s salary as it relates to premium calculation                  
  • AMERICAN TPA Premium Billing System & Services can allow a member to be excluded from premium calculation               
  • AMERICAN TPA Premium Billing System & Services can allow multiple active policies per member in the same premium calculation                      
  • AMERICAN TPA Premium Billing System & Services can generated when premium calculation is completed / finalized              
  • Premium invoices be automatically sent to responsible party via                              
    1. Email                    
    2. FTP Site                               
    3. Portal                   
  • AMERICAN TPA Premium Billing System & Services can receive automatic updates from GL system when premium is received                         
  • AMERICAN TPA Premium Billing System & Services can partially apply a cash receipt to a premium invoice            
  • AMERICAN TPA Premium Billing System & Services can audit which policies have / have not had premiums calculated                           
  • AMERICAN TPA Premium Billing System & Services can can calculate administrative fees for premiums  
  • AMERICAN TPA Premium Billing System & Services can allow custom modifications to the premium invoice which is sent to policy holders    
  • AMERICAN TPA Premium Billing System & Services can allow premium invoices to be billed in a currency other than your functional / reporting / default currency    
  • AMERICAN TPA Premium Billing System & Services can receive premium payments in currencies other than your functional / reporting / default currency                              
  • AMERICAN TPA Premium Billing System is integrated with Microsoft

American TPA Premium Billing Solution for Health Exchanges

We have deep capability around Premium Billing & Accounting Services (PBAS) and is tuned to serve Health Plans & Qualified Health Plans (QHPs) for Health Exchanges.
Our 2-in1 Software cum Services includes:

  • Accommodates members with different online user capabilities and language preferences
  • Controls function-by-function access by individual users with automatic error detection
  • Employee options and comfort levels will improve through the use of a simple, easy-to-understand experience
  • Enhances reliability and extensibility
  • Facilitation and tracking of payments by employers and employees to the QHPs
  • Health plan information can be reviewed online, making plan comparison and selection easier
  • Innovation and improvements in affordability and quality
  • Interfaces with HIXs to receive entire enrollment, disenrollment, and termination, as well as update renewals
  • Lowered costs through improved operations and administration
  • Processing HIXs fees and navigator payments
  • Provides reports and data with privacy protections as required
  • Provides supporting documentation to HIXs as requested
  • Quickly responds to market demands
  • Seamlessly integrates with public and private plan options and enrollment process
  • Serves as an intermediary between health plans and HIXs to allow seamless initial enrollment processing as well as verifications against information for renewals
  • Tracking of enrollments 
For more details on AMERICAN TPA HealthCare Services & Plexis Claims & Premium Billing System, call 201.258.4704
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Contact Information

425 Washington Blvd.,
Jersey City,
New Jersey 07302,
USA

Phone: +1 551.227.1525 | +1 201.258.4704
Fax : +1 201.604.3480
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