Antares' administrative services are built upon a solid foundation of systems and applications. Our infrastructures are modular to provide maximum flexibility and capacity expansion. Antares administrative services can include any or all of the following:
Call Center
Antares' call center environment includes dedicated phone lines, sophisticated systems and experienced professional customer service representatives. The combination of staff and systems has proven to help our clients reduce operating costs while maintaining higher than industry average service levels. Our call center support can reduce your operating costs and increase the quality of your service.
Calls are answered on a first in, first out basis, and overflow calls are answered by trained back-ups to the primary designees. Customer service calls are monitored daily online and as needed through both digital recording and documentation review, to ensure quality. All monitoring is conducted by managers and quality assurance staff.
On a monthly basis, Antares tracks numerous service levels based on the services provided as part of each contract. Standard items tracked and reported for customer service include:
Standard Service Level Agreements
- Calls received
- Calls answered
- Calls abandoned
- Calls blocked
- Percentage of calls answered in 20 seconds
- Average call time
- Inquiries open (aged by date ranges)
- Inquiries by type of question
- Inquiries by type of caller (i.e., provider, member, etc.)
Commission Processing
Antares' systems automate the production of commission statements, commission checks, check registers, contract information and agent licensing information. Commission premium records are created through an automatic payment application process. These records are then run through a six-part process that creates pre-commission statements, error record reports and commission calculations; and prints agent statements, checks and check log reports. Commissions are based on product definitions that link to agent schedules, which are used to calculate commission percentages. Commission checks are drafted on the client's bank stock and Antares' administrative support area answers all broker-related commission issues via a toll-free line or connection from the dedicated customer service unit. Our system currently supports paying renewal commissions on the initial premium.
Claims Processing
With its extensive infrastructure and resources, Antares can serve as your organization's claims processing center, managing all claims-related needs. Features of the claims system include electronic processing, medical policy, adjudication and the integration of reimbursement methodologies.
We accept EDI claims from national and regional networks as well as clearinghouses. Claim submission and adjudication tasks are modularized for sharing code between online and batch processes. EDI/batch adjudication reports are available to identify the total number of clean claims and the exception category breakdown (i.e., non-clean claims: rejected, pended, paid, dropped and/or suspended). A monthly batch history report identifies each exception category and the percentage of claims within each category.
Coordination of Benefits (COB) functions are integrated with claims and eligibility. COB is calculated as a carve-out, maintenance of benefits or standard COB. Benefits can be coordinated at the benefit line or summary level.
The systems maintain a coverage history for each member, supporting multiple iterations of effective and termination dates for each product.
Benefit and Policy Administration
Antares will initially load all unique benefit designs into the system, then verify, test and confirm in addition to ongoing maintenance and administration of the benefits.
Reporting
In addition to a number of reports available daily, weekly, monthly, annually, etc., in an electronic format, Antares can provide access to a customer-secured data warehouse updated on a frequency determined by the client.
Data Security
We can tailor our backup philosophy to fit your company’s needs. At a minimum, Antares will take a daily backup of information and vault it at an off-site storage facility.
Compliance
Antares Management Solutions understands the insurance industry and the importance of staying up-to-date on the latest state and federal mandates, such as HIPAA and ERISA regulations. Our company is licensed in all 50 states, Puerto Rico, the U.S. Virgin Islands and Guam. We track legislation and mandates on a regular basis and assist clients in attaining compliance within established time frames.
Enrollment, Eligibility & Membership
Antares' systems provide maximum flexibility in membership and billing services by combining enrollment and billing functions into a single database. A client/server version is available to meet the business needs of third-party administrators and other organizations that want to combine enrollment and billing data from various insurance plans into a single, easy-to-read invoice.
The systems allow changes to a client's name, certificate number or social security number without the need to manually change the client's past records. If an insured changes groups or location, has a break in service, or terminates and is rehired, all previous eligibility information is still available and can be accessed.
To protect confidentiality, the access rights to eligibility records can be controlled for different levels of personnel.
Enrollment
Connexionii by Antares is an online application that provides instant, secure, HIPAA-compliant access to membership, eligibility and claims transactions 24-hours a day via the Internet. Through the Connexionii by Antares portal, an employer can enroll/delete or change new insureds and dependents, update membership information, perform 270 and corresponding 271 transactions, select healthcare products (health, life, dental, vision, etc.) and message the carrier's business units.
Member Identification
Antares' systems provide clients with the flexibility to produce identification cards that can be customized by group. The production of custom ID cards can be handled by each client upon completion of the appropriate technical training.
Financial Administration and Banking Services
Antares provides three different types of deposits through our cash collection process,: lockbox, street checks and electronic fund transfers.
- Lockbox: Checks mailed to a designated PO Box segregated from all other Antares customers
- Street Checks: Loose checks incorrectly returned to departments within Antares or directly to customer offices
- Electronic Fund Transfer (EFT): Preauthorized payment (check) from the policyholder's bank account
We maintain a preferred banking relationship and setup, which is customized based on customer needs.
Imaging & Optical Character Recognition (OCR)
The use of imaging technology for claims and correspondence has reduced the need to manually enter data, lowered capture costs and improved processing rate accuracy. A customized software application allows our customers to scan claims and correspondence, drive electronic queue routing and retrieve inquiries online. Using ICR/OCR technology introduced the capability to convert incoming paper claims into an EDI format. This solution provides cost savings by automating a portion of the manual data entry process.
Premium Billing
Antares provides premium billing services for about 20,000 policyholders. Generally, premiums are processed the same day as received, depending on the complexity of client business requirements. We provide for proration on new business and individual additions and terminations.
Billing Options
Billing modes currently supported are monthly, quarterly, semi-annual and annual. Billing rules can be established on a customer-by-customer basis. We have capabilities to bill for and receive the premium payment by cash, check or Electronic Funds Transfer (EFT), deposit and apply to each policyholders' account. Overpayments and underpayments are processed according to our clients' requests. Antares' premium collection process posts cash, tracks overages and shortages, maintains premium suspense, and reflects accurate accounting information.
Antares' supports self-administered, list and summary bills. Multiple benefits displayed on one billing statement can be accommodated. Turnaround time averages 24-hours from in-house bill generation to mailing. Generally, premiums are processed the same day as received, depending on the complexity of the clients' business requirements.