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Computer System

Automated Claims Payment System, Island Group's automated claims payment system, was designed expressly for our requirements and the needs of our clients. It is a fully automated, on-line, interactive system that is both flexible and versatile and able to meet the needs and growth of our organization as well as our clients. The system adjudicates medical, dental, vision, and Flex 125. In addition, the system automatically accommodates any type of benefit features including PPO claims, interactive UCR tables, managed care provisions, etc.

The Island Group, Administration Inc. computer system is a UNIX based system. Unix is recognized the world over as one of the most stable and versatile operating systems in existence today. This system can upload and download data from most standard OS environments and has full data exchange capabilities. Our claims adjudication system in proprietary and was created to meet to needs of IGA and our clients. We have yet to reach the limitations of this system, if any. In addition, we have had minimal down time to date, and have been certified by both software and hardware vendors. This system is fully capable of batching claims into a "single episode of care.". This system is fully capable of automatically detecting:

  • Overpayments
  • Potential Fraud
  • Provider fee unbundling, up coding, aberrant billing
  • Quality of care concerns
  • Potential case management
  • Appropriate R&C schedules

There are no limitations or restrictions in our claims administration system and network operations that would prohibit or limited our efficient claims processing. A full description of internal quality control and auditing procedures was conducted and addressed areas of investigation, frequency, qualifications of auditors (internal and external), follow-up on negative findings, method of audit, etc. IGA conducts hospital bill audits on a routine basis.

Island Group Administration does maintain geographically specific "reasonable and customary" (R&C) charge screens for all practitioner fees and medical procedures (e.g., Ingenix). Our current out-of-network and optional indemnity plans use Ingenix at the agreed upon percentile. The choice of percentile is generally discussed with the Plan Sponsor at the time of account setup.

 
 
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