THIRD PARTY ADMINISTRATION

For over 25 years, Simonpietri Hemisferica has provided access to high quality, convenient, and affordable Vision and Dental Benefits. Hemisferica is a leader in innovative health care solutions for health plans, employer groups, and third-party administrators. Hemisferica’s robust capabilities deliver ease of administering health care benefits and excellence in customer service for all of our customer groups.

COMPREHENSIVE TPA SERVICES

• Claim Processing and Adjudication

• Claim Re-pricing and Paying

• Utilization Review and Management

• Eligibility and Enrollment

• Self-Serve On-Line Enrollment and Administration

• ID Card Generation

• Comprehensive Standard and Ad Hoc Reporting

• Centralized, Consolidated Billing with Multiple Location/Division/Class Breakout

• Friendly, Accurate, and Professional Customer Service

• HIPAA Compliant, Prompt Pay and Timely Filing Adherent

• COBRA ADMINSTRATION

Claims Processing

• Promptly process and pay claims, as well as many other day-to-day aspects of a managing a vision and / or dental benefits plan.

• Provide a buffer and protection against abuses of employee health privacy rights.

• Save you money with fraud prevention, call center services and other economies of scales.

• Distance the employer from claim disputes.

• Over $100 million in claims processed and paid annually.

• Industry Experienced Claims and Customer Service Professionals.

• Provide Services for Kaiser Permanente, Providence Health Plans, Regence BC/BS