www.ers.net

• Utilization Review
• Multi State licenses
  • Pre-certification/Pre-authorization-review of information for medical necessity for proposed treatment
  • Concurrent Review-determines medical necessity of continued stay
  • Retrospective Review-determines medical necessity of care already provided
• Case Management
  • Coordinator-encourage continuity of care by communicating effectively with all parties
  • Advocate-for the client and payor by assessing treatment and help maintain cost effectiveness
  • Educator-Trained professionals who can assess medical information and provide ongoing education.
  • Facilitator-Evaluate work status for return to work
• Bill Audits
  • Review of hospital records to ensure relatedness and to ensure charges are supported in the medical record.

• Multi State licenses
• Pre-certification-Prospective-Concurrent-Retrospective Review
  • Determining medical necessity
  • Determining appropriate level of care
  • Evaluating the quality of care and expected outcome
  • Exploring alternative levels of care
• Case Management
  • Manage and Reduce Cost
  • Improve Client and Provider Satisfaction
  • Obtain Timely Information on High-Cost Cases
  • Improve the coordination and delivery of care
• Technology
  • Access to online Criteria-Milliman
  • Ability to send nightly file sends of precerts and notes
  • Ability to download eligibility files
  • ACD telephone system
• Professional Staff
  • Licensed Registered Nurses
  • Certified Case Managers
    • Nurses with a broad knowledge base of clinical medicine that combines education and experience.
    • Effective communication skills
    • Knowledge of alternative resources
    • Creativity in problem solving
• Support Staff
  • Trained clerical staff for intake and data input

• Qualifying Event and Enrollment Beneficiaries

  COBRA and HIPPA laws programmed into system to identify the qualifying event and benefit eligibility, and determine the length of eligibility.

• Customization

  ERS has several custom options that allow select variations

• Billing and Payment System

  ERS can bill premiums by using coupons or monthly premium notices, and maintain a payment history in which all information about payment from participants is stored.

• Audit Trail

  ERS maintains a history of all events, dates of correspondence, and Compliance-required events so that complete information about each beneficiary can be quickly and easily obtained.

• Automatic Letter Processing

  The key element of ERS’ COBRA Administration is that all documents are generated automatically by the system.

• Reports

  ERS offers 20 standard reports that display detailed information Regarding participants, benefit plans, premiums collected andnotificatoin letters produced.

• DOL Model Notices

  ERS prints the “DOL Model Notice” required for new employees as they Become covered by the employ’s benefit plan automatically.

• Coverage Certifications

  Recently enacted HIPAA law requires employers to provide “Coverage Certification” to departing employees and dependents. ERS automatically prints these certifications.

• Administering the family and Medical Leave Act of 1993

  ERS enables the administration of on-leave participants.

• Compliance

  ERS COBRA Administration personnel attend necessary educational seminars to keep abreast of the ever changing updates to the COBRA/HIPAA law.