• Why National Benefits Administrators?
    It is not business as usual at National Benefits Administrators. Unlike many ‘TPA’s’ that are bottom line driven, many times at the expense of the brokerage community and employer, we strive to work in concert with our customers and consultants.  With the combined strengths of managed care and technologically advanced systems we provide not only information, but more importantly, the ability to understand and digest information.

  • Systems
    NBA has the systems and experience to control benefit costs….

    We utilize the Resource Information Management System QicClaim/2 medical claim management solution, widely acknowledged as the premier system for managed care administration. Our integrated system automatically links eligibility and claims data, identifies duplicate claims and charges, coordinates benefits, applies specific plan rules and calculates benefit payments.

    Aided by our new Integrated Voice Response System, our Customer Service team can respond to employee and provider inquiries promptly and accurately.

    With integrated claim systems, provider processing services, network access and large case management, we can control healthcare spending without sacrificing quality of care.

  • Reporting
    In addition to the standard reports, NBA can collect detailed information from employees, claims,  providers, and Rx vendors that can be combined and reported on an ad hoc basis.

  • Web Based Capabilities
    NBA has placed an emphasis on web-based services. Our web functionality allows easy to use access to enrollment and reporting systems. This information is provided in a user friendly format and can be suitable for various audiences.
  • Network Access
    We can provide a managed healthcare delivery system regardless of geographic location and we have a long history working with national and regional independent networks.

  • Medical Management
    Medical Management is a services that needs more emphasis as a method for controlling claim costs. We implement a three pronged approach to medical management:
    • Disease Management – Asthma, Diabetes, Coronary Artery Disease, Oncology
    • Care Management – Pre-cert, Transplant Network, Large case management etc.
    • Health Management – Wellness tools, Prenatal programs, 24/7 Nurseline etc.
  • Large Case Management
    Large Case Management provides another opportunity for claim control. A series of specific diagnostic procedures and utilization indicators can be used to identify potential large cases early in the treatment cycle.  Early intervention provides the best opportunity to coordinate care and to actively manage healthcare expenses…before costly therapeutic decisions have been made.

  • Pre-Admission Review
    Pre-Admission Review is conducted on all scheduled (non-emergency) hospital admissions to assure that services are medically necessary and performed in the most appropriate setting. Care is redirected to outpatient facilities or other facilities when medically appropriate.

  • Medical Necessity
    Using well established clinical criteria, NBA evaluates whether a proposed procedure is medically necessary.  NBA also evaluates the cost effectiveness of the delivery system.  If our criteria for medical necessity are not met, a NBA Medical Director discusses the case with the treating physician to determine an appropriate course of treatment.

  • Cobra Administration
    NBA can provide all the services employers need to comply with COBRA regulations. Including initial notification, election options, billing etc.

  • Section 125
    NBA offers complete administration for section 125 plans that are integrated with the claims system.  Monthly and quarterly statements facilitate management of Dependent Care Spending and Non-Reimbursed Healthcare Spending Accounts.