Health and Welfare

Scalable solutions and services.


Eligibility Maintenance and Billing Capabilities

  • Maintenance of all necessary information — personal, general, coverage and eligibility spans
  • Retrospective additions and terminations
  • Timely and accurate identification card preparation
  • Unlimited plan and coverage changes with complete history
  • Multiple levels of eligibility breakdown — by group, division, department or area
  • Maintenance of premium and rate data
  • Premium reconciliations
  • Tracking of commissions

Successful Managed Care Programs

  • Pre-admission Review Certification
  • Large Case Management
  • Built in Maternity Management programs
  • Demand Management
  • Disease Management
  • Nurseline
  • Health Information Website
  • Health Risk Assessments

Premium Operational Performance

  • Extensive system and data reporting capabilities
  • Broad range of statistical reports to monitor plan performance
  • Regular quality review testing
  • Data integrity commitment
  • On-line repricing data for numerous Preferred Provider Networks (PPOs)
  • Internal auditing

RDS Medicare Subsidy

  • Coordination of RDS reporting requirements between Zenith American, the PBM and Medicare.

HIPAA Compliance

  • Privacy
  • High tech security
  • 834 & 837 files
Coordination with PPO Vendors & PBM's across the nation.