SOMI’s accuracy and performance record is exemplary. Our average claim cost per employee consistently falls below the national average by 10%-20%. We credit our success, in part, to our audit and management procedures.
As your TPA, we can do it all:
- Design and build your plans on our claims systems
- Manage and contract with all plan vendors such as PPOs, PBM, Stop Loss, UR, specialty services
- Assist in rate and financial guidelines for appropriate funding
- Handle all enrollment and eligibility loads and feeds
- Draft legal plan documents and on-going amendments and plan changes
- Produce ID cards and required forms
- Coordinate transition from current administrator
- Perform enrollment meetings
- Implement legal updates and legislative requirements
- Integrate claims processing with Ingenix and PPO partners
- Perform EDI transmission and receipt
- Integrate with and monitor PBM
- Provide trigger diagnosis reporting and disease management program
- Manage coordination of benefits
- Prepare and manage appeals
- Provide maternity and specialty care management
- Present monthly claims and analytical reports
- Offer multiple funding options
- File 1099s
- Prepare 5500 tax forms
