Solutions

Flexibility. Transparency. Cost Management. 


HMA is bringing managed health solutions that save employers substantially on health care spending to the marketplace.
HMA SOLUTIONS

Self-Funded Health Plans

HMA’s proven self-funding methods allow employers to control their claims spending by covering the actual cost of claims as they occur, instead of paying substantial premiums dollars to insurance companies for coverage. Many self-funded health plans avoid costly state and federal benefit mandates, while also providing the flexibility to determine the best benefits to meet employee needs and company objectives. As a result, self-funded plans provide better benefits at a much lower cost than the employer could obtain from most insurance companies. Our self-funded plans provide strategic solutions for all in-network, out-of-network, high-dollar, complex, pharmacy, and dialysis claims. This is made possible through network hierarchies, proactive negotiations and coordination with stop loss insurance.

Our solutions provide a road map towards controlling future health care costs.

Self-Funding through HMA delivers:

Increased Financial Control

Lower Operating Costs

 Benefit Flexibility

Access to Valuable Data

Best-in-Class Administration


Full-Service Administration

HMA’s team of industry experts deliver the highest levels of claims adjudication, customer service, case management and many other services surrounding our flexible self-funded plan designs.

Pharmacy Benefits
HMA Rx delivers national accessibility with convenient, cost-effective options to prescription drugs. Our specialty drug programs help clients manage the prices of costly drug therapies.
Electronic Banking Solutions
Safe and secure banking and fiduciary solutions add value to any benefits package through consolidation, accuracy, and financial protection with a centralized electronic benefits payment service.
Ancillary Products
Ancillary products allow employers to offer their employees a complete benefits package based on the unique needs of their workforce, which include dental, vision, telemedicine, and other health care solutions.
Compliance Management
HMA always ensures that all benefits are in compliance with any applicable rules and regulations. You can rest easy that your plan is maintained within all state and federal regulations.
Provider Network Solutions

We provide a variety of provider network solutions that make it easy for employers to gain deeper insight into their plans. Our provider network plans can be customized using our preferred vendors or those of our clients.

Reporting and Analytics

HMA delivers advanced reporting and analytics tool for self-funded employers and producers. Our team helps provide insights into each plan and suggestions to support your plan goals.

Stop Loss Insurance

Stop loss insurance solutions provides cataclysmic protection for our self-funded medical and specialty prescription drug plans. Flexible options are available based on group size and budget.

COBRA Administration

COBRA administration can be complex and time-consuming. HMA has solutions to administer COBRA program benefits, including compliance, financials, and reporting on behalf of our clients.

THE EVOLUTION OF HEALTH PLAN INTEGRATION

Precis Integrated Health Plans are genuine alternatives to high-cost health insurance plans that continue to see premiums rise at an excessive rate. Precis Plans utilize quality service and consumer transparency to deliver substantial cost savings and enhanced benefits for any size self-funded employer group. Precis Plans combine industry leading cost-containment solutions with flexible plan designs, leading stop-loss contracts, pharmacy benefits, and other health management tools. This integration is truly what makes Precis unlike any other health plan.

PRECIS INTEGRATED HEALTH PLANS INCLUDE:

Precis Integrated Health Plan Designs

Precis Plans offer a variety of fully integrated plan options that meet the needs of any size self-funded employer. View the Precis Plan comparison guide here to see for yourself just what Precis Plans offer.

HMA SOLUTIONS

Value-Based Pricing

Unlike traditional provider networks that claim to negotiate lower fees off the hospital/provider’s billed charge, value-based pricing (VBP) from HMA is a revolutionary concept that differs from the more traditional provider network options. VBP delivers transparency in the pricing of most medical services based on economical reimbursement levels. Specifically designed to be fair and reasonable, VBP is determined by various pricing data sets, most notably, Medicare. With over 95% of medical facilities across the country accepting Medicare reimbursements, it is the most common pricing structure for medical services in the United States. Value-based pricing can reduce any employers claims spending on employee medical benefits up to 40% when compared to traditional PPO networks.

Thinking of switching to a VBP Plan?

HMA’s detailed claims analysis showcases the financial savings that a VBP plan can deliver to any employer group. This report determines the exact pricing for claims based on actual claims billed and claims paid with an established Medicare reimbursement for each inpatient and outpatient service. To request a claims analysis for your business, please click the link below.

ADVANTA helps members choose quality providers and save on their out-of-pocket costs, while also eliminating balance billing.

HMA’s Member Advocacy program, Advanta, educates and guides members throughout the entire VBP process. Our team of advocates determine which providers will accept VBP first. From there, they coordinate your care and act as your single point of contact for all payment and billing questions. Advanta educates and negotiates with health care providers before your health care services are performed. Our proactive process is paramount for eliminating the potential for financial liability. However, if a provider does send you a bill, Advanta will work on your behalf to get it resolved and keep your costs as low as possible.


ADVANTA Services Include:

Member and Patient Support

Advanta provides both pre-service and post-service patient support for members needing care under their value-based pricing program.

Scheduling of Services

Once a case reimbursement agreement is established, our team of advocates are always standing at the ready to assist patients in scheduling.

Manage Certifications & Referrals

The Advanta team manages all certifications and pre-authorization referrals for the patient receiving care.

Pre-Service Negotiations

Patient advocates work directly with providers prior to perform any services and negotiate and agree to reimbursements defined by the plan benefits.

Alternative Provider Options

In rare instances when a provider does not accept the defined benefit reimbursement, Advanta will provide alternative options for care that will accept the defined reimbursement.

Assistance With Balance Billing

In rare cases where patients receive a balance bill, Advanta’s experienced team will work directly with the provider to resolve the bill and relieve patients of any additional financial liability.

PNOA is a nationwide, direct, contracted provider network.

In today’s health care environment, consumer needs are complex and continuously shifting. For that very reason, PNOA is proud to be the provider of flexible network solutions that offer simple implementation and robust administration all across the board. PNOA offers a range of flexible networking solutions to fit any employer’s needs. With an experienced and aggressive contracting department, PNOA will fill the gap in an effort to produce the cost savings you would expect from a leading nationwide network.

Solutions for Payers and Advisors

Whether a self-funded employer, TPA, insurance carrier, Taft-Hartley Trust plan, Native American Tribe or advisor, PNOA provides an extensive provider network that virtually ensures substantial savings on health care costs. PNOA delivers competitive discounts and maximizes savings for patients who utilize in-network providers and facilities.

Direct Provider Contracting

PNOA contracts directly with providers to deliver competitive discounts and maximize savings for patients who utilize in-network providers and facilities. The PNOA team of industry experts are trained to develop contracts that are mutually beneficial for the patient, the payer, and the provider.

Our Proprietary Technology Makes it All Possible.

The Precis Technology system is a comprehensive, tightly integrated suite of applications that manages all aspects of our healthcare enterprise. Precis Technology software is maintained by in-house development staff.

System Integration

The ease of Precis’ system integration limits the need for other outside parties, which are often exactly where those added costs hide in system integration.

•  Real-Time Claims Processing

•  Consolidating OOP Maximums

•  Real-time Workflow Management

•  Plan Building Capabilities and Testing

•  Claims Pricing for a Variety of Networks

Compliance Support

Consistent updating ensures that secured applications are kept up to date with all industry standards, requirements, and state and federal mandates.

•  HIPAA Compliant

•  5010 and ICD-10 Compliant-Ready

•  RACA Mandates

Comprehensive Reporting

Precis generates standard reports that cover all areas of health plan administration. Each client can select reports to view and choose the frequencies in which they want to receive them.

•  Monthly, Quarterly and Annual Reports

•  Benefits Reports

•  High Costs and Savings

•  Enrollment and Coverage