EPOCH provides a comprehensive administrative product set that allows our clients to streamline their workload by working with one vendor to coordinate a full array of services. Our well-trained and compassionate employees are responsive to the unique needs of our self-funded employers and their members.

Technology
EPOCH utilizes the industry leading TRIZETTO/RIMS claims system. This system allows for all the HIPAA requirements to ensure privacy and protection of PHI. EPOCH coordinates claim acquisition through several Electronic Data Interchange clearinghouses, and paper claims are scanned into our system using Optical Character Recognition (OCR) technology. EPOCH regularly auto-adjudicates claims with flexible plan designs that meet the requirements of our clients. We interface the system with state-of-the-art Internet tools that allow our clients to easily manage their enrollment and claim information. We have fully integrated applications for claims, eligibility, billing, COBRA/HIPAA, and customer service. EPOCH also reprices claims on behalf of a number of managed care networks.

Our approach integrates fully customized claims processing, web services, health management, customer service, and reporting. Further, our claims processing focuses on claim cost management through the use of:

      •  Subrogation identification
      •  System edits and triggers for LCM referral
      •  Out-of-network fee negotiation and settlement
      •  Fraud detection software
      •  Hospital audits

Stop-Loss Placement and Management
EPOCH will work with the employer and their brokers to evaluate the various stop-loss options. EPOCH has vast expertise in the placement of specific and aggregate reinsurance. In addition, we are able to leverage the volume of business we control to the client’s benefit. Our market experience gives you the peace of mind knowing that you have purchased the most comprehensive coverage at the most competitive premium.

Once a carrier has been selected, EPOCH will manage the integration with the stop-loss carrier. EPOCH monitors and reports all claims that are approaching the pre-determined specific (individual claim) or aggregate (group) amount, coordinates all billings, files all claims, and provides monthly and annual renewal reviews.

Funding Arrangements
Clients establish their own bank account for their Plan. EPOCH prints and distributes all checks with explanation of benefits (EOBs) based on the requested frequency. We also provide detailed check registers including drafts, voids, refunds, and checks paid.

Claims Processing and Customer Service
EPOCH’s dedicated claims teams are well-trained and experienced to handle even the most complex benefit plan designs in a prompt and courteous manner.

EPOCH has a team of Customer Service Representatives that are empowered to handle a variety of questions, including claims issues. Our goal in customer service is "one call resolution."

Quality Assurance Program
EPOCH is committed to providing clients with accurate and timely claims processing, as well as excellent customer service. Continuous Quality Improvement includes a monthly random audit program, target audits, and ongoing training programs.

Random audits are performed on the following departments:

      •  Coding/Verification department
      •  Provider Maintenance
      •  Pricing
      •  Pre-Certification Entry
      •  Eligibility
      •  Customer Service
      •  Claims

The quality assurance program incorporates several documented methodologies, including an annual SAS-70 audit performed by an outside audit firm.

Reporting
EPOCH’s goal is to provide each client with the information they need, when they need it! Our commitment is to provide the best possible plan data and analysis tools. The essence of productive plan decisions rests in the ability to easily transform raw data into meaningful information resulting in actionable steps that allow effective plan management.