Services - Health Benefit Management - CBCA Administrators, Inc. The Employee Service Organization

Medical

CBCA works with employee groups to provide a scalable, customizable solution for their medical administration management. We have access to over 100 regional and national PPO networks. We can seamlessly integrate and administer multiple networks in multiple locations for groups of all sizes.

Dental

CBCA partners with several leading dental networks providing over 87,000 dental professionals to our clients and their members giving them the ability to select the vendor that best fits their specific needs.

Vision

CBCA has the capability to offer a wide array of customized plan designs, based on the needs of each client. Through a strategic partnership with one of the nations largest providers of eye care coverage, our clients receive "best in breed" vision plans from an industry leader.

COBRA / HIPAA

Let us handle the time-consuming details of complying with the notification and reporting requirements of the Consolidated Omnibus Reconciliation Act (COBRA) and the American Recovery and Reinvestment Act (ARRA). By combining regulatory knowledge, administrative expertise and state-of-the-art technology, CBCA can help you comply with COBRA, HIPAA and other regulatory requirements.

FSA / HSA / HRA

Combining advanced technology systems with friendly, live customer service, CBCA offers end-to-end administration for FSA, HSA, HRA that delivers a full suite of services. Debit card technology, prompt reimbursement, and online account access increases member utilization and satisfaction, and ensures that you are getting the most retention power out of your benefits offering.

Short Term Disability

CBCA will process your disability claims only when they occur, so you avoid paying monthly premiums for periods which may have no claim activity.

Out-of-Network Bill Review

As an optional component of our provider network administration, CBCA offers stand-alone bill review and fee negotiation for services rendered outside of the PPO network.

Subrogation

CBCA subrogation (third party liability and recovery) services assist clients in the recovery of dollars paid for healthcare expenses that are determined to be the responsibility of a third party, such as a workers' compensation administrator, homeowner's carrier or an automobile insurer.

CBCA patient-centric care management approach identifies potential gaps in care through early intervention based on patient needs. Nurses work with patients and physicians to determine the appropriate level of care, care setting, and continuing care needs. CBCA's Care Management program is based on principles that have yielded a 3:1 to 5:1 return on investment for employers.

Precertification, Medical & Behavioral Health

Our URAC-accredited utilization review services - preadmission certification, concurrent review, in-patient and out-patient management and retrospective review - ensure appropriate care and medically-necessary treatment is performed in appropriate settings before costly, unnecessary claims occur. We collaborate with providers using evidence-based guidelines to help ensure members are receiving the correct care in the correct setting. Nurses guide members to appropriate network practitioners and facilities. Cases are referred to Case Management and rates are negotiated when out-of-network care is unavoidable, minimizing wasted healthcare resources for members and the plan. Our process covers both medical and behavioral health in-patient and out-patient services.

Acute & Complex Case Management

URAC-accredited Complex Case Management is an outreach initiative to engage members and/or their caregivers in intensive case management to support and assist them with interventions designed to stabilize their conditions and facilitate services needed to maintain medical and psychosocial stability. Complex Case Management focus is on those members who are largely unable to fully care for themselves or manage their illnesses. Our multidisciplinary programs are geared to support members who are experiencing chronic, debilitating life threatening illness that will benefit from active and aggressive interventions to return the members to the maximum possible health status and quality of life.

Chronic Care Management

This program is designed to effectively transition identified members from complex to chronic and, if appropriate, end-of-life care management services. It will also continue the "whole-person" approach using universal and condition specific surveys to identify gaps in care, implement target interventions and educational efforts with a focus on:

Empowering the member to manage their own condition
Reducing barriers that prevent compliance to medical guidelines and the physician's treatment plan
Reducing and eliminating complications
Focusing the nurse case manager on clearly defined interventions and outcomes

Maternity Management

Complications during pregnancy can be frightening, confusing and costly. Healthy pregnancies result in fewer complications and preterm births, higher birth weight, less absenteeism, and reduced claim costs. Mothers-to-be enrolled in CBCA's Maternity Management Program may avoid many complications associated with pregnancy. We offer support by educating mothersto- be about their pregnancy and how to avoid risk throughout the pregnancy.

Nurse Help Line, 24/7 with Extensive Audio Library

CBCA's Nurse Help Line is a triage, advice, referral and health-counseling service that provides employees and their family members with around-the-clock access to registered nurses. Using guideline-based assessment tools, our nurses have access to both the PPO network and consumer-focused healthcare information. The Nurse Help Line operates from a URAC accredited call center. Results show that clients experience up to a 37% reduction in the incidence of emergency room visits, a similar reduction in urgent care visits and a 42% reduction in unnecessary physician visits.

Wellness

From early identification to active management, CBCA’s wellness program addresses the entire health of our member population. Our wellness program is aimed at improving health, promoting wellness, and managing healthcare through telephonic and web-based interaction between members, care providers and care managers.

Cancer Treatment Validation

Studies show that 15% of diagnoses are incorrect, 25% of treatment plans deviate from guidelines, and 45% of patients do not comply with prescribed treatments. CBCA's Cancer Treatment plan reduces inappropriate use of drugs and radiation therapy, improves network efficiency, and in the most serious condition promotes early use of hospice and palliative care in end-of-life situations. When available, our program validates and facilitates the appropriate participation in high quality clinical trials.