Claims Processing and Management

HDP utilizes the Eldorado® claims adjudication system — considered state-of-the-art in the industry. With the flexibility of Eldorado and our highly experienced staff, our clients are provided with options of maintaining the type of managed care arrangements that best suit their needs. We manage numerous types of healthcare plans for our self-funded clients. We have the ability to duplicate existing plans or can custom design a specific plan. Our claims management staff ensures that claims are processed efficiently and accurately through our secure adjudication system. Our account managers are in tune with our client's needs on a day-to-day basis to address all questions, requests, or concerns.

The following are examples of the claims processing and management services available:

  • Consultative approach to Plan Design
  • Dedicated Client Management Team
  • Medical/Dental/Vision/RX/STD Claims Administration
  • Secure and administer stop-loss coverage
  • Develop, implement and manage Cost Containment Programs
  • Utilization Management, Pre-Certification
  • Large Case Management
  • Lifestyle and Disease Management
  • Assist with enrollment presentations, implementations, and management
  • Large claims and out-of-network claims negotiations
  • Network and Provider management
  • ID Cards
  • Provide Claims, Eligibility and all Administrative forms and materials
  • Provide EOBs and Checks
  • Banking
  • Plan Documents and Amendments
  • Administer Reasonable and Customary charges
  • Collect and distribute premiums to appropriate vendors and stop loss carriers
  • Extensive Reporting
  • Ad-hoc Reporting and Analysis
  • COBRA Adminstration
  • HSA/HRA/FSA Adminstration
  • Consumer Tools and Education