First Choice Health Administrators (FCHA)

First Choice Health Administrators’ claims processing system is highly integrated and technically savvy. Claims are processed electronically, many automatically. Our performance in claims turn-around time and claims payment processing accuracy is monitored and reported to be above the industry standard benchmarks. Coordination of Benefits (COB) is an integrated function of our claims administration.

First Choice Health Administrators can administer COBRA for our self-insured clients. COBRA is managed according to federal rules and guidelines for self-funded employers through premium billing, record keeping and ongoing communications.

First Choice Health Administrators provides members with the reliable and dependable online tools to help guide them through making decisions about their own healthcare needs. These web-based tools include:

Procedure Pricing

Gives an average cost based on the type of service provided by your physician, such as an office visit or diagnostic tests.

Prescription Pricing

Through our preferred Pharmacy Benefit Manager, get information about prescription costs and network pharmacies. In addition, compare generic to brand name prescriptions to get an idea of potential cost savings.

Hospital Quality Indicators

Compares hospitals by zip code on information such as costs, diagnosis, procedures and complication rates.

Conditions and Diseases

Provides reliable and extensive information related to symptoms, diseases and conditions that help guide you through treatment and medication options as well as testing procedures and questionnaires that help you determine your need for medical care based on your symptoms. In addition, there is advice about what to discuss with your physician in order to make informed decisions about your healthcare.

Resource Links

Gives outside links to resources that can provide members with additional information and guidance in helping to make the best decisions about one’s healthcare.

Doctor Information

Provides basic professional information on virtually every licensed physician in the United States. This includes more than 690,000 doctors.

Chronic Condition Management

For guidance with chronic conditions, such as Coronary Artery Disease, Diabetes, Asthma, Congestive Heart Failure, or Musculoskeletal Condition, FCHA partners with UMR Care Management to help you learn more about your disease, symptoms, and treatment plan and offers experienced nurses to guide you every step of the way. You can also get general health and wellness information from the UMR Care Management website.

Reporting Capabilities

First Choice Health Administrators has a leading-edge health care analytics system called MedInsight, a Milliman Product. This analytics system not only allows FCHA to provide a comprehensive monthly and quarterly reporting package, but allows us to provide in-depth analysis of cost drivers, outcomes and provider performance.

First Choice Health Administrators’ Customer Care Team are well trained and knowledgeable of the various employer benefit plan designs and client specific requirements. All calls are documented, tracked and monitored for quality assurance purposes. Our call center service performance is continuously monitored and reported to be above the industry standard benchmarks.

FCHA currently operates in two locations in Washington. FCHA's corporate administrative office is located in Seattle with our main operations office located in Spokane. Employees have one toll free number they can call to reach customer service assistance with enrollment, benefits, claims, pre-authorizations or any other need. Members can contact our Customer Care Representatives by phone during our normal business hours, Monday thru Friday, 7 am to 5 pm (Pacific Standard Time).

In addition, members have access to their eligibility and claim status 24 hours a day, seven days a week via our Interactive Voice Response system. Of course, with access to the Internet, members can also utilize myFirstChoice, our online customer service application, which provides detailed member information.

First Choice Health Administrators accepts enrollment from plan sponsors (employers) via traditional paper enrollment forms or electronic data transfers from the employer’s system to ours. Once the enrollment data is loaded into our system, Member ID card is generated for each plan participant.

First Choice Health Administrators offers Healthcare and Dependent Care Flexible Spending Account administration to employer sponsors who may choose to offer this funding option to their employees. A Mastercard Debit Card is automatically included for each participant in the Healthcare account. Medical benefits must also be administered by FCHA. Employees have instant access to FSA claims status and account balances through myFirstChoice.

Flexible Spending Account (FSA) Defined

A flexible spending account (FSA) program is a great way for employees to manage their health care and/or dependent care expenses through the use of pre-tax dollars.

• Use of pre-tax dollars reduces taxable income.
• Use up to your total election amount at anytime during the plan year even if you have not yet contributed the full amount to your FSA account.

FSA Enrollment

Find out if your employer offers this option. Then during your Open Enrollment, estimate the amount of out-of-pocket expenses you will have for medical and/or dependant care expenses for the coming year. You will contribute to your account(s) with pre-tax dollars taken in equal amounts from each paycheck during the plan year.

FSA Reimbursement

This money is distributed from health care and/or dependent care accounts upon submission of a claim for a qualified eligible expense. There are guidelines around qualifying expenses that are available through myFirstChoice.

FSA Debit Card Integration

FCHA offers an integrated Debit Card solution through Evolution Benefits. Participants use their Debit Card to pay for qualified expenses directly out of their FSA. Because of federal regulations, participants are required to submit receipts for their medical expenses even when using a debit card. To further reduce this burden on employees, FCHA has integrated its FSA processing with it’s medical and dental claims processing to auto-substantiate a good majority of these claims resulting in reduced requests for substantiation.

FCHA administers Health Reimbursement Arrangements for employer sponsors who choose to offer this funding option as a benefit to their employees. Members have instant access to HRA claims status and account balances through myFirstChoice.

Health Savings Accounts are for employer sponsors who choose to offer this funding option in conjunction with a qualified High Deductible Health Plan. FCHA is well versed in administration of these designs and integrates with several pharmacy benefit managers on the deductible and out-of-pocket expenses.

Employees have instant access to HSA claims status and account balances through myFirstChoice.

FCHA has administered over 200 variations of benefit plans, and can likely administer any type of design on the market, including:

Medical

• PPO Plans
• Consumer Directed Health Plans
• High Deductible Health Plans
• Point of Service Plans
• Managed Care Plans
• Medical Home Plans
• Medical System Based Plans (ACO’s)
• Value Based Benefit Designs
• Pharmacy Integration

Vision Plans

Dental Plans

Our Medical Management Department is URAC Accredited for Case Management and Health Utilization Management and features an experienced clinical team with a full-time onsite Medical Director. First Choice Health offers a full spectrum of Medical Management services, including:

Utilization Management

Precertification

The general focus of Precertification is on all elective inpatient admissions and targeted impactable outpatient services.

Inpatient Concurrent Review & Discharge Coordination

Inpatient Concurrent Review & Discharge Coordination incorporates daily clinical rounds by the FCH Medical Director and clinical team to identify potential gaps in care and evaluate appropriateness of care.

Outpatient Gap Interventions

Outpatient Gap Interventions is a unique program that uses available claims and pharmacy data to identify enrollees with diagnoses and care patterns that are likely to adversely impact the employee's health and workplace productivity. The attending practitioners of identified enrollees benefit from a phone conference with FCH's Medical Director to evaluate treatment effectiveness and options.

FCH's approach to addressing health care gaps via inpatient concurrent review and outpatient gap interventions significantly differentiates us in the marketplace. It is a collegial approach that is appreciated by the provider community and brings outstanding results of enhanced care coordination, improved employee productivity, and health care dollars saved.

Comprehensive Case Management

FCH Case Managers interface with patients, families, treating providers, and facilities to coordinate patient-focused treatment plans that incorporate judicious use of benefit dollars. Care plans include personal support for the patient and family, assistance in obtaining necessary medical services and equipment, and consideration of customized care options. Case Managers are instrumental in assisting patients and their families as they navigate the complexities of the health care system.

Mental Health/Chemical Dependency

First Choice Health is uniquely poised to respond to the rapidly growing demand for effective, professional management of behavioral healthcare services. Our internally developed program is called FCH Behavioral Health Coordinated Care. In addition to a menu of world-class employee assistance program services, FCH delivers flexible options for pre-certification, authorization, gatekeeper functions, depression disease management, and utilization review of inpatient and outpatient mental health and chemical dependency treatment.

Clinical Appeals & External Review

First Choice Health has met compliance requirements related to the Patient Protection and Affordability Care Act (PPACA) requirements surrounding Claims Appeals & External Review process. Through our External Review partners we provide timely evidence-based medical appeals review by specialty-matched health care professionals.

First Choice Health has shown an excellent response time for all appeals, consistently meeting 100% compliance for the state and URAC mandated turn around times. Appeals are fully tracked and documented within our software.

Health Promotion Services

First Choice Health in partnership with American Health Holding provide an array of leading-edge Health Promotion Services. These services are offered as an integrated adjunct to Utilization and Case Management services.

The goal is to provide participants with education and tools to improve their overall health. Programs are available to assist people across the spectrum of health, from those who are currently healthy to those who are chronically ill. Programs include:

24/7 Nurse Line: First Choice Health provides nurse line services that enables easy confidential access to timely health education and guidance.

24/7 Physician Consultations: Getting expert medical advice from a doctor has never been easier. In addition to consulting with a physician by phone or secure email, this service includes a one-stop health portal that allows members to search for a specific health topic then click to consult with a doctor via phone or email.

Maternity Management: Enrollment is voluntary and easy. Members can self refer. Contact begins early (first trimester is ideal) and continues through pregnancy and after delivery. If a high-risk enrollee is identified, case management is begun. Registered nurses educate members by phone and through the mail.

Health Assessment and Biometric Screening: A Health Assessment (HA) is included in the Wellness Web Portal to evaluate health status and health-related productivity. The HA and biometric screening may be used as a trigger for enrollment in the Disease Management or Wellness programs, as applicable.

Wellness Web Portal: our wellness portal is an option with on line tools to support participants to reach their personal health goals. In addition to the HA, the wellness portal includes a personal health record, 24/7 live nurse chat, health and wellness library, and other interactive easy to use tools.

Wellness Coaching: We offer one-on-one telephonic intervention with a personal health coach to targeted members at convenient times to the employee. Our team of personal health coaches includes health professionals from a variety of backgrounds, such as dieticians, nurses, health educators and exercise physiologists. Information and counseling is geared to participant need and interest.

Disease Management : Specific chronic disease management programs include, but are not limited to, diabetes, asthma, coronary heart disease, congestive heart failure, chronic obstructive pulmonary disease,chronic pain (back pain, osteoarthritis, and rheumatoid arthritis), hyperlipidemia, and hypertension. The customized programs provide education and support to help program participants, across all levels of illness, understand and manage their chronic diseases.

First Choice Health Administrators (FCHA) has partnered with MedImpact a Pharmacy Benefit Manager (PBM), which provides value-added services to FCHA and their clients. FCHA partners with MedImpact to provide clinical and technological expertise to manage pharmacy utilization and costs through enhanced utilization review and clinical management. Services offered include:

• Transparent and Aggressive Traditional Contract Pricing
• Comprehensive Pharmacy Network Access
• Mail Order Services
• Clinical Expertise and Support
• Flexible Plan Design Options
• Formulary Design & Management
• Utilization & Trend Reporting
• Transparent Rebate Access
• Online Pharmacy Tools
• Drug Interaction Assessment
• Specialty Pharmacy Services

First Choice Health Administrators (FCHA) is available to draft Summary Plan Descriptions on behalf of the Plan Sponsor and in cooperation with the Plan Administrator. FCHA is diligent in our research and study of the regulatory environment for self-insured plans including ERISA, COBRA, HIPAA, Mental Health Parity, Newborns & Mothers Health Protection Act and the Women's Health & Cancer Rights Act.

FCHA is pre-approved by top-rated stop-loss carriers:

• HCC Life
• HM Insurance
• ING
• ISU/Companion
• Medical Excess
• Munich Health
• OptumHealth
• SunLife
• Symetra
• Zurich

First Choice Health Administrators (FCHA) administers the terms of the stop-loss agreement related to notification and reporting for employer sponsors.