Medical and Dental Plan Administrative Services

SAS provides comprehensive medical and dental plan administration, either separately or combined. SAS strives to provide the highest quality service available to our clients and their employees and dependents. Our goal is to assist your organization in designing and implementing innovative strategies for maximizing service while containing costs.

Claims & Data Management

Our systems provider, Quality Care Solutions, Inc.™ (QCSI), was recently awarded the "Microsoft Industry Solutions Award for Healthcare Services" for the QMACS / SAS claims and data management system. SAS utilizes the QMACS data software system for tracking eligibility and adjudicating claims.

Claims Adjudication Services include:

  • Data Entry

  • Mass Adjudication

  • Individual adjudication of pended and denied claims

  • Claim reworks and investigations

  • Individual adjudication of claims with special circumstances

  • Check Generation

  • Explanations of Benefits (EOB)

  • Coordination of Benefits (COB)

  • Subrogation

Network Access & Management

SAS maintains close relationships with many carefully selected networks capable of meeting each client’s specific needs. The Network Management Department is responsible for recommending an appropriate provider network based on the client’s specific census data and other individual considerations through the use of sophisticated accessibility analysis tools. Once contracted, the department acts as the liaison between the client and the network, and monitors changes in the network to ensure that it continues to be an appropriate match.

The vast majority of national and regional networks are unable to offer the coverage necessary to ensure the highest level of member satisfaction and the greatest cost savings to the employer. National and regional PPO networks generally offer adequate coverage for the prominent hospitals and larger physician offices in an area, but overlook many of the smaller providers and ancillary facilities. The result is increased cost for the employer and decreased employee satisfaction with the health benefits.

Over the years, SAS has developed a proprietary network that includes:

  • Physicians

  • Physical and Occupational Therapists

  • Other Non-Physician Professionals

  • Mental Health Practitioners

  • In-Patient and Out-Patient Treatment Facilities

  • Durable Medical Equipment Providers

  • Centers of Excellence for specialized care (i.e. organ transplants)

As part of our General Administrative Fee, SAS provides all clients access to our proprietary network and preferred discounts. SAS understands that individuals often have very different preferences in terms of meeting healthcare needs. As a result, not only does SAS supplement your PPO of choice with our proprietary network, but we also maintain the ability to contract with additional providers and facilities to meet individual client preferences.

Provider Relations

SAS is one of the few Administrative Service Organizations to maintain a Network Management Department that employs active Provider Relations Representatives. They are responsible for provider office staff education, orientation, and issue coordination. If a local provider office is identified as having a specific problem or issue, such as balance billing, a PR Representative is dispatched to the office to investigate the issue and seek a resolution. Due to this program, SAS’s provider satisfaction is consistently high, billing problems are few, and members do not incur administrative hassles.