Eligibility Maintenance and Billing Capabilities

• Maintenance of all necessary information — personal, general, coverage and eligibility spans
• Retrospective additions and terminations
• Timely and accurate identification card preparation
• Unlimited plan and coverage changes with complete history
• Multiple levels of eligibility breakdown — by group, division, department or area
• Maintenance of premium and rate data
• Premium reconciliations
• Tracking of commissions

Successful Managed Care Programs

• Pre-admission Review Certification
• Large Case Management
• Built in Maternity Management programs
• Demand Management
• Disease Management
• Nurseline
• Health Information Website
• Health Risk Assessments

Premium Operational Performance

• Extensive system and data reporting capabilities
• Broad range of statistical reports to monitor plan performance
• Regular quality review testing
• Data integrity commitment
• On-line repricing data for numerous Preferred Provider Networks (PPOs)
• Internal auditing

RDS Medicare Subsidy

• Coordination of RDS reporting requirements between Zenith American, the PBM and Medicare.

HIPAA Compliance

• Privacy
• High tech security
• 834 & 837 files