The following criteria are used when selecting new benefit providers:

Experience and track-record in delivering a quality product and/or service in a timely, customer-sensitive manner
Accountability and acknowledged financial stability
Desire to continue or expand commitment to association, affinity group and company programs
Willingness to work in a creative, “outside the box” fashion to incorporate unique benefits, pricing and/or value
Sound marketing and administrative support
Ability to offer provider location referrals, inbound telephone inquiry response and timely customer service
Our administrator mandates high standards for provider participation. Providers must agree to participate in all quality assurance programs and meet strict credentialing guidelines.
   
   
Quality Assurance

Quality assurance in all programs is ensured in part due to our administrator's vendor test call process
Weekly calls are made to multiple network providers in order to gauge the true member experience
If a test call is unsatisfactory a report is sent to the network so they may contact the provider for re-education
Networks follow up with researcher to detail the resolution
This test call information is included in monthly report to senior management
On an on-going basis, the administrator's executive team actively researches the marketplace for new services, better pricing, and/or deeper discounts to either replace or complement the programs.
On-going price and discount analysis is performed on a quarterly basis to ensure members receive the very best price and quality for these services. Our administrator has achieved its current level of success by nurturing client relationships through the consistent delivery of exceptional customer service and value.
   
   
RECRUITING:
In house networks (CTC and UHS Chiropractic)

If a member’s favorite provider is not part of the network they may contact Provider Relations to nominate him or her.
Member must provide provider’s name, telephone number, and address.
Provider Relations then contacts the provider to explain the program and attempt to contract the provider.
The member is then contacted to inform him or her of the provider’s decision.
Initial contact with the provider is established within 7 – 14 days
Average turnaround time on contracting a new provider is 35 – 45 days

All other networks
Members may contact Provider Relations to nominate their favorite providers in all other networks, as well.
They will be asked for the provider’s name, telephone number, and address.
These nominations are then forwarded to their respective networks for recruitment.
   
   
PATIENT ADVOCACY:
Hassle-Free Visit for Aetna Dental and UHS Chiropractic programs
Member calls Member Services to locate a provider in their area
Member Services issues Patient Advocacy request
Patient Advocates search the member’s area for participating providers
Patient Advocates then call provider’s offices to ensure they acknowledge participation in the plan and understand how to properly bill the member
Patient Advocates will contact and confirm 2-3 participating providers within 20 miles of the member’s ZIP Code within 1 to 2 business days
Patient advocacy not available in CA.
   
PRODUCT DEVELOPMENT:
Research Process
Our goal is to bring the best benefits to our groups and members
Proactive market research is conducted to identify new and unique benefits
Multiple vendors are often reviewed in an effort to align with the best vendor of each particular benefit program
Researchers perform due diligence on each proposed benefit
Due diligence includes investigation of the company, network (including test calls to providers)
Upon selection of a vendor, researchers coordinate all aspects of program implementation, from helping to facilitate the contract process to actually launching the benefit
After the program is launched, researchers endeavor to maintain a superior working relationship with each vendor and work in conjunction with all departments to ensure complete satisfaction for our brokers, groups, and members.

{ Close Window}