Take the Hassle Out of Plan Configuration

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Plan Configuration Made Easy

Benefit packages are increasingly complex, and offering an attractive benefit plan helps to increase the strength of self-funded and fully insured plans. One of the most significant features of these plans and mastery over the subsequently required health claims processing is control over the precise benefit structures. Healthcare payers that support these plans require a claims administration system with the flexibility to accommodate innovative plan designs while leveraging the technology to drive automation and ensure claims are paid accurately. The older legacy plan and benefit management systems are tedious and labor-intensive, especially during busy enrollment periods or staffing shortages. With a new vision, Beacon has designed SpyGlass to offer a clear, flexible, and dynamic approach to streamline your plan configuration processes.

Plan and benefit design are at the heart of claims administration. SpyGlass utilizes a rules-driven approach to control how payments are calculated. Business users can manage how charges and services interact with the HIPAA required code sets and transactions. These business rules define all the basics, like co-pays, networks, co-insurances, service and dollar limits, but go beyond to manage related things like pre-authorization, benefit groups, tiered benefits, member demographics and even specific types and groups of providers.

Benefits in SpyGlass are defined at a base-level by unique benefit and exclusion rules that dictate what sort of claim you’re talking about. At the benefit level, you can set complex benefit calculations, charge and service number controls, and build in routing to user-defined workflow queues as needed. With the business and user-driven plan configuration that SpyGlass offers, your business users can control every aspect of multifaceted benefit plan designs and reimbursement arrangements for multiple products and multiple lines of business, including medical, dental, vision, flex, disability, and life benefits.

Administer any line of business with SpyGlass

Medical Benefits Medical
Achieve dramatic rates of auto-adjudication and administer a broad range of complex medical plans.
Flex Benefits Flex
Track elections, pledges, employer contributions, account balances, and link to your choice of debit card vendor.

Dental Benefits Dental
Uniquely sculpt dental plans, with built-in edit rules, tooth chart tracking, and procedure standardization.
Disability Benefits Disability
Robust support for STD and LTD claims includes taxes, deductions, rounding, payment frequencies, and waiting periods.
Vision Benefits Vision
Control limits on exams, contacts, frames, and lenses with full-on automation controls.
Life Benefits Life
Manage life claims to serve critical illness and accident plans with flat benefit amounts, rounding controls, beneficiaries, and relation codes.

Using an older system to build benefits and plans is traditionally a manual effort fraught with tedium and manual effort. It doesn’t have to be that way, but it requires a new approach.

SpyGlass offers elegant tools to manage coverage and benefit structure that makes plan building extremely efficient. We’ve externalized most of the business logic out of benefits and coverages themselves and into external tables, allowing you to just maintain things like groups of related codes (procedure or diagnosis) or the specific values of benefit limits like deductibles, copays, and coinsurance amounts in distinct reference tables. These become immediately referable on the actual benefit rules or coverages. The key advantage of this is that it gives you the ability to set up benefit rules and maintain them very quickly, and very easily—changing only what you have to change, in as few places as possible. It’s like seeking an optimal leverage point.

For example, you can maintain two identical coverages, but allow them to use different levels of deductible. Additionally, you can create external procedure and diagnosis code tables, so that ranges of codes like MRI, CT Scans, and PT Scans can be easily re-used across different groups throughout the system without having to look up and enter all the relevant codes for each benefit.

Beacon also delivers SpyGlass with intelligently designed pre-configured benefit and coverage templates so that you don’t have to start from scratch during the plan building process. The SpyGlass “copy” tool allows for quick and easy modifications to coverage templates or existing benefits without having to recreate them. You can not only copy benefits or exclusions from one group to another, but also copy entire coverages and plans from one group to another, which copies all the associated underlying artifacts used by the original plan.

To accumulate certain service types (i.e. chiropractic, acupuncture, etc.) based on service counts or paid or charged counts, SpyGlass offers dynamic accumulators, benefit maximums. These powerful features allow you to set specific limits on the number of services that may happen within a particular timeframe, along with the added ability to have multi-tiered accumulations. For instance, a chiropractic benefit can limit to 1 visit per week, 4 visits per month, and not to exceed 26 visits per year. You might think of this as “concentric circles” of benefit limits, using ever-larger limits.

Outdated, legacy claims systems continue to cause inefficiency, instability hurdles, and ultimately a loss of value to their clients. Their traditional plan configuration processes can create a lot of issues that may lead to last-minute rush, significant manual efforts, and inaccuracies in data. Gain the flexibility to coordinate more transformative benefit administration with SpyGlass, and drive operational best practices as well as customer satisfaction.

Wrestling With Plan Design?
Seamlessly manage benefit plan configuration with Beacon's transformative solution.