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TPA Services:

Insured claim administration

Insured claim administration

Responsive, accurate and cost-effective claim processing is the core of our company. Rather than trying to be all-things-to-all-people, Cambridge Administrators is a dedicated claim adjudicator specializing in the participant accident, intercollegiate sports, K-12, Catastrophic and related accident medical markets.

Successful administration partnerships are based on a thorough knowledge of the client's activities, membership and protection needs. Cambridge prides itself on the ability to comprehend, interpret and apply nuances of Special Risk coverage in a manner consistent with efficient and effective outcomes. Our access to over 150 medical provider networks on a national, regional and local basis, regardless of the claim size, creates a unique opportunity to more effectively manage your costs. Thorough analysis of every claim, inclusive of other primary coverage determination, is consistently applied.

We believe long term relationships are built on personalized "first name" service. Our experienced and dedicated staff knows and understands your needs. After-hours access to claim status via our 24/7 web portal expands our availability to meet your schedule.
Deductible/Aggregate/Self-funded Administration

Deductible/Aggregate/Self-funded Administration

Following a similar philosophy as "insured" administration, we provide identical administration services to those clients who desire a level of self-funding for their risk exposure. We offer these services predicated on a service agreement that parallels the insurance element, or if completely self-funded, under arrangements the client selects. We also can accommodate specific payment arrangements that may be outside the scope of the insurance product. Many clients who utilize their own staff to process reimbursements find significant savings when the complete tools available to us are applied.

A seamless approach is utilized on a per injury deductible or aggregate deductible administration, ensuring a single claim filing suffices for the entire processing component. Ongoing reporting, invoicing and funding balances are provided to meet your accounting needs.
Catastrophic claim administration

Catastrophic claim administration

There is an inherent risk associated with participation, particularly within athletics or physical competition. Many organizations elect to provide extensive catastrophic protection for those rare but potential catastrophic injuries that may impact individuals beyond the normal recovery anticipated.

Cambridge Administrators is centered on individuals who successfully built one of the most recognized teams in the participant accident market. Beyond the efficient and effective processing of medical expenses, a true need exists to deliver a level of care, coordination and respect for those critical and challenging injuries that can be life-changing. We offer the time-tested responsiveness that allows families to focus their attention on recovery initiatives while we anticipate and coordinate those elements of coverage that seamlessly integrate with medical needs. Depending on the extent of coverage, that can extend beyond traditional medical expense reimbursement, often including home modifications, transportation alternatives, family training, travel reimbursement, disability payments, home health care arrangements or even college course enrollment.

Insurance carriers may also arrange our services to help families effectively extend "Catastrophic Cash" benefits should such coverage be available. This helps ensure the most favorable pricing arrangements are secured for the most effective care arrangements.
Risk Management

Risk Management

A variety of initiatives exist today in an effort to "capture" the incidents surrounding injuries. One of the most effective and accurate methods to complement those efforts is the proper tracking and reporting of actual injury claims within the claim administration systems. Our flexible systems are designed to anticipate the type of incidents associated with your organization that then allows us to not only capture the data, but to provide you details on a composite level that identifies the risk elements associated with your organization, whether that be by sport, activity or other factors. We also have the capacity to bench-mark your results against similar organizations or institutions.

Risk management is most effective when you understand exactly where your risk exposure resides. We offer the injury tracking elements as an inclusive component of our claim administration.
Provider network access

Provider network access

Our claim administration approach extends well beyond simple claim processing. We apply a built-in EDI approach that incorporates access to over 150 medical provider networks, using a single network aggregator that identifies the most cost-effective networks in the area of the client. We can offer solutions for uninsured student athletes to gain optimal pricing arrangements and can work within your existing medical provider structure to maintain or enhance your savings.

While you often see "comparative" discount percentages that competitors tend to wave as "better" than everyone else, those of us directly in the industry know how figures can be manipulated. The pricing model we have elected is applicable across the board on all charges. We believe the broadest application of providers against the broadest volume of claims, at historically consistent deep discounts, will consistently lead to the best results for you.
Case management

Case management

The most demanding type of specialized accident medical coverage administration is associated with those complex cases where the nature of the injury is more consistent with long-term impact to the participant. True catastrophic injury administration often can require a level of coordination beyond the broad competencies of the claim team for optimal outcomes. We offer Nurse Case Management services when the complexities or severity of the case are best managed by a professional Registered Nurse certified in Case Management.

The human interaction between medical teams and families often is the difference between an adequate level of care and a complete coordinated approach. RN Case Managers engage with doctors and medical facilities… and most importantly, the family… to ensure complete coverage components can respond appropriately to medical recommendations. They often become the critical connections between families struggling to understand the medical complexities and having an understanding medical resource they can depend upon. Our Case Management approach extends to discharge planning, physical accommodations analysis, transportation and home care assistance.

Cambridge Administrators, LLC is a Third Party Administrator with proven competencies in the Special Risk participant accident, intercollegiate sports, catastrophic injury, AD&D, Disability, Aggregate Deductible self-funding and K-12 markets. We also support and process medical expense, trip interruption/cancellation and related travel components for many of the largest international programs worldwide. Our diligent focus on specialized market segments provides you the Best in Class service approach that ensures coverage is properly applied, claims processed and data captured in a manner consistent with the highest service standards in the industry.

As an independent TPA, we have the capacity to extend our claim processing and service reputation to your clients and participants, providing not only prompt, efficient and accurate service, but the reporting tools that help you understand and manage your risk exposure, local/regional/national provider network access that controls your loss experience and 24/7 online connectivity to your claim data.

Your complete satisfaction is our ongoing measure of success.

SERVICE – SOLUTIONS – SAVINGS – SUSTAINABILITY

CAMBRIDGE ADMINISTRATORS LLC

5832 S 142nd St, Suite A

Omaha, NE 68137