Our Products / Services
ASO / Self-Funding Administration
Hammerman & Gainer offers a full complement of services which can be tailored to the needs of any organization. Services include:
- Turn-Key Administration
- Enrollment and Eligibility Processing
- Premium Administration
- Claims Processing (Adjudication)
- Utilization Management
- Provider Network and Contract Management
- Claims Recovery (Subrogation / COB)
- Reinsurance / Stop Loss Protection
- Plan Design Consulting
Turn-Key Administration
H&G seeks to provide the highest quality administrative services. We interface operationally with clients through a unique client support and turn-key administration. This service bureau strategy uses the expertise of an exceptional staff to provide the support you need to meet the demands of the ever-changing healthcare environment.
Enrollment and Eligibility Processing
Sophisticated and accurate information systems are the most important element of a successful Third Party Administrator. H&G is proud to provide a full complement of Member eligibility and enrollment processing services designed to facilitate the enrollment process and track accurate member information.
Premium Administration
The financial strength and viability of your organization depends up timely billing, reporting and communication. H&G provides options that can be tailored to fit your organization’s specific needs.
Claims Processing (Adjudication)
H&G provides an unparalleled depth of service in the claims processing arena, including:
- Inpatient hospital
- Outpatient hospital
- Physician, Dental and Ancillary Provider claims
- Prescription Drugs
These services, in particular, will free your team to focus on the increased demands of your growing organization.
Utilization Management
In a world where rising medical costs and increased demand for resources require constant management, hospitals, health plans and physicians face new challenges to meet multiple goals. H&G offers the unique services of health care oversight for hospitals, health plans and physicians.
Provider Network and Contract Management
Providers, networks, case rates, discounts, etc., provide for a complex demand and careful management of the provider networks and associated fee schedules. H&G’s experience and management expertise will create greater efficiency for your organization.
Claims Recovery (Subrogation & COB)
While claims processing is the lifeblood of your organization’s financial fitness, the claims recovery process is critical to cash flow management and projections. H&G’s administration provides comprehensive claims recovery services match your needs, including, coordination of benefits, third party liability, refund posting, and Medicare coordination.
Reinsurance / Stop Loss Protection
H&G maintains relationships with ‘top shelf’ reinsurance carriers and intermediaries that can provide you with individual (Specific) and group (Aggregate) protection for your self-insured employer /employee group health plan. The services provided by our reinsurance partners promote financial security, integrity, savings, accurate and timely reimbursement and choice.
Plan Design Consulting
As you chose your Administrative Services Organization (TPA), carefully consider the number of benefit designs and parameters that can be supported. H&G can assist you in making recommendations to your HMO, PPO, POS, EPO, Traditional Indemnity (Fully Insured) plans, as well as your ASO / Self-Funded Healthcare programs.
To get more information, please call (800) 929-9525 or click here
Healthcare Administration Services
- Limited Medical Plans (LMP)
- Medical Flexible Spending Accounts (MedFSA)
- Dependent Care Assistance Program (DCAP)
- Healthcare Reimbursement Accounts (HRA)
- Transit and Parking Management Accounts
- COBRA Administration
- ASO/Self-Funded Claims
Project Management / Consulting
Federal Business Sector