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HealthSCOPE Benefits’ success has long been recognized in our ability to lower our client’s healthcare spend and produce healthier members through Total Health Management®.  Our programs are custom designed to meet the unique challenges for each client.  Going beyond traditional medical management programs, Total Health Management® aligns the programs and services offered to each client to improve member health and maximize savings for the Plan.  HealthSCOPE Benefits’ Total Health Management® is data-driven to help identify, analyze, and turn data into action.  Our action plans incorporate clinically focused care management, integrated solutions, and member education to help build a culture of health, productivity, and an engaged workforce.

  • Benefits Management

    Plans Designed to Drive a Culture of Health

    Benefits Management

    Planning and implementing your benefits program requires understanding of the key factors influencing the buyers of healthcare – your members. HealthSCOPE Benefits is prepared to help identify the programs and services that will suit your population and the goals of the Plan. We offer a full range of vendors and services to provide the best-in-class. We recognize you may have vendor partners and relationships currently in place that you will want to transition to HealthSCOPE Benefits. That’s why HealthSCOPE Benefits affords you the flexibility to continue your relationships when switching to us for your claims administration. We will work to integrate your vendor partners with our systems to provide a seamless transition to HealthSCOPE Benefits for you and your members.

  • HSB TotalSCOPE Care Solutions

    Care Solutions

    HSB TotalSCOPE Care Solutions

    We offer a broad scope of integrated care management programs designed to take a 360-degree view of the member. Our TotalSCOPE Care Solutions include a full range of medical management programs, including pre-certification of inpatient and outpatient services, concurrent review and discharge planning, as well as specialized programs for reviewing high-cost radiology, specialty obstetrics, and mental health services. Our case management data resources compiles member data from a variety of sources such as medical and pharmacy claims, lab results, and information provided directly from the member. By reviewing this data, we can identify gaps in care, emerging trends, and other cost driving factors in the Plan. This information can assist our case managers in directing members to quality care at the right time and in the right place.

  • Claims Management

    Commitment to Claims Payment and Customer Service Excellence

    Claims Management

    Processing and managing claims takes proficient systems, skilled people, and a keen understanding of the complexities of our healthcare system. HealthSCOPE Benefits has all these attributes and more. Our claims payment system is state-of-the-art with the flexibility to administer the most complex plans. We use a combination of integrated clinical edits, fraud abuse detection, as well as edits for bundling and unbundling of claims to provide the most sophisticated claims editing available. Our Claims Examiners are highly trained and focus their attention on processing the claims correctly the first time. To deliver our outstanding customer service, all calls regarding claims are handled by Customer Care Representatives.

  • Advisory Services

    Bringing the Next Frontier in Healthcare to Life

    Advisory Services

    As one of your most trusted partners, we work around the clock to bring you the most innovative approaches to benefits design and medical management, offering your organization and your members the most value. We have decades of experience creating optimal solutions with the specific needs of our clients in mind. Industry partners want to work with us and we are often one of the first to learn about new ideas. We promise that when there is not an available solution in the marketplace, we will work with you to create one.

  • HSB DataSCOPE™ Analytics

    Accountability. Actionable Data. Timely Reporting.

    HSB DataSCOPE™ Analytics

    We lead the industry in our data warehousing, analytics and reporting capabilities available through our proprietary HSB DataSCOPE™ tool. This information helps our clients understand exactly where their healthcare dollars are going, how this compares to benchmark information, and informs data-driven strategies and solutions. HSB DataSCOPE™ surpasses other information systems in its ability to apply advanced clinical methodologies to healthcare claims data. While other systems monitor only cost and utilization, HSB DataSCOPE™ considers data from a clinical perspective as well, accounting for factors such as age, sex and severity of illness when evaluating plan and provider performance. As a result, clients can make more accurate decisions regard benefit plan evaluation and management. Our latest tool release provides our clients with self-service, web-based reporting access.

  • Network Solutions

    Unsurpassed Network Services

    Network Solutions

    Our network solutions team is focused solely on locating or creating the perfect managed care network for your organization. Whether you want a narrow network, best access, or are focused on the discounts, we provide solutions that effectively address the needs of both you and your members.
    • Access to 140 regional, national, and high-performance networks

    • Ability to develop and manage direct contracts and ACO arrangements
• Creation of specialty network access, such as custom designed Centers of Excellence
    HealthSCOPE Benefits started as a network development business, so we understand the importance of having the access to the best network solutions.

Contact Us

HealthSCOPE Benefits is committed to serving self-funded employers with innovative solutions for their complex benefits needs. Let us help you build the plan that works best for you.