our services

Medical, Dental, and Vision Plan Administration
Advantek offers a proprietary claims processing department with 20 full time processors who have extensive experience with self-funded claims administration for any size employer group covering their employees, dependents, and retirees.

Consolidated Vendor Billing
Advantek’s vendor billing service provides our clients with a comprehensive and timely solution for managing all of the client’s health plan disbursements on to one audited, accurate and consolidated billing statement for payment on a monthly basis.

On-line Eligibility
Advantek offers an on-line tool (Comprehensive Enrollment Wizard or CEW) to allow employers to update and manage their enrollment, as well as run reports on current census categories. This also will give employers on-line access to up-to-date eligibility information from who is covered, to what benefits the employee elected or which dependents are being covered.

ID Card Preparation
Advantek prints employee identification cards daily, and has the capability to customize ID cards for each client, including a logo. ID cards include medical, dental and pharmacy benefit information, PPO network, Employer Name, Office Visit Co-Pay, Group number, UR requirements and toll free number, Customer Service toll free number, and claims administration address. The card is always pre-approved by the employer.

HIPAA Compliance and Administration
Advantek is fully committed to a compliant HIPAA implementation strategy. Our goal is to ensure we provide the necessary notifications and certificates. We work with your employees and providers to gather the necessary information to calculate and track the appropriate deadlines and implementation standards.

In-House Utilization Management
Advantek’s Utilization Management staff uses established national medical guidelines to evaluate the medical necessity for hospitalizations and outpatient services and the appropriateness of the overall treatment plan. Our programs combine the knowledge and experience of our registered nurse reviewers along with our board certified Medical Director to help direct patients and their providers towards the most cost effective, quality treatment available. Our UM Program consists of the following elements:

• Precertification review - certification of medical necessity prior to an elective admission to an acute care facility or prior to the rendering of outpatient services.
• Concurrent review – assessment of medical necessity and the appropriateness of continued inpatient confinement.
• Discharge planning – coordination of the discharge process to expedite the transfer of the patient from the acute care setting to an alternative, more appropriate care setting. A more appropriate setting may be a skilled nursing facility, home health care, or a rehabilitation center.
• Evaluation of the patient’s need for Large Case Management.

Our UM Program allows the flexibility to be structured to meet and match the criteria of each client’s benefit plan and to most effectively address each plan’s areas of highest utilization and cost. As experience data is accumulated, utilization patterns will be monitored and the program can be modified further to address changing needs and usage patterns.

On-Site Medical Director
As an Advantek client, you have unlimited access to medical advice through our in-house medical director, Daniel Bluestone, M.D. Dr. Bluestone is trained in Pediatrics, Neurology, and Pediatric Neurology from UCSF. He is board certified in Neurology and Pediatrics which gives us a unique advantage in one-on-one dealings between Advantek and its provider panel and other hospitals providing care in the Central Valley. Under his direction, medical decisions are reviewed to ensure that Advantek’s patients receive the most appropriate, high quality medical care.

Large Case Management
The purpose of the Advantek Case Management Program is to ensure that members who require extensive or ongoing services are provided with medically necessary care in the highest-quality, most cost-effective setting possible. Our staff of 4 Nurse Case Managers coordinates individual services for members whose needs include ongoing medical care, home health, hospice care, and rehabilitation services. The functions of large case management include:

• Assessment of the patient’s medical status and needs.
• Coordination of care with medical providers, facilities or home health organizations.
• Identification of network providers and Centers of Excellence; direction of care to network providers.
• Identification of other resources available in the community; coordination of community services with plan services.
• Providing assistance to the patient/family in appropriate medical-care decisions.
• Provide help to the patient/family in resolving benefit and/or claim issues.
• Recommendation of coverage exceptions where appropriate.
• Watch for opportunities to negotiate lower rates with out-of-network providers.
• Encourage and facilitate less costly alternative plans of care: for example, home care vs. hospitalization.
• Educate members to ensure compliance with medication management and self-care.

Summary Plan Document Preparation
Plan documents are not only reviewed by staff at Advantek, but also reviewed for ERISA compliant wording by an outside agency. Examiners and Customer Service Representatives are provided with a copy of the summary plan documents. In addition, a snapshot (high level overview) of the documents are prepared and provided to the users for easy viewing.

COBRA Administration
Advantek provides full service COBRA administration to assist you in becoming COBRA compliant . We have a COBRA specialist on staff with 26 years experience. Our staff is compliant with current legislation and kept up to date with continued education. Services include the following:

• Prepare and mail General COBRA notification
• Prepare and mail qualifying event notice to employee and dependent(s)
• Provide election enrollment materials
• Coordinate payments and monthly statements
• Update eligibility
• Participant Report
• Administer qualifying events and disability extensions
• Termination of coverage at end of eligibility period

FSA Administration
We provide a comprehensive Flexible Spending Account (FSA) program that enables eligible employees to pay for certain medical and dependent care expenses with pre-tax dollars. In addition, your staff and participants will enjoy Evolution Debit Card for Point-Of-Service Payment and Online Access for Participants. We generate employee interest in the plan and create positive atmosphere for the enrollment process. Employees currently have two claims submission options – fax or mail. Reimbursements are sent directly to employees’ homes or by direct deposit.