What We Offer

AdminOne provides a full suite of services to streamline claims administration, ensure compliance, and improve plan performance. Our platform supports claims processing, investigation, adjudication, and payment - with tools that help members and providers submit, track, and manage claims, view payment status, and access ongoing support resources.

Claims Adjudication
Services

Efficient Claims Processing: Ensure timely handling of all claim submissions to maintain processing speed, accuracy, and regulatory compliance.
Thorough Claims Investigation: Conduct comprehensive verification of coverage, in-depth documentation review, and evaluation of claim-related details to uphold integrity.
Accurate Claims Adjudication: Validate claim eligibility, calculate benefits with accuracy, and finalize determinations that reflect policy terms and service standards.
Claim Payment Processing: Complete approved claim payments with accuracy and speed to maintain trust, reduce delays, and support overall satisfaction.

Compliance &
Regulatory Support

Regulatory Compliance: Ensure all claims comply with federal, state, and industry requirements - supporting consistent, compliant operations.
Fraud Detection & Prevention: Investigate potentially fraudulent claims to reduce risk and ensure accurate claims processing.
Compliance Support: Support ongoing compliance through organized workflows, clear documentation, and alignment with industry and legal standards.
Ongoing Compliance Monitoring: Continuously track changes in legislation and industry standards to keep processes current and reduce compliance risks.

Cost Containment &
Risk Management

Medical Bill Review: Ensure accuracy and cost-effectiveness in medical claims to prevent overpayments and reduce plan costs.
Provider Negotiation: Work directly with healthcare providers on Reference-Based Pricing claims to achieve fair and sustainable cost agreements.​
Utilization Assessment: Evaluate the medical necessity of procedures to control healthcare costs while ensuring appropriate patient care.​
Risk Management: Implement strategies that reduce high-cost exposures and support the long-term financial health of the plan.​

Member & Provider
Support

Member & Provider Communication: Deliver reliable support to members and providers - addressing questions and offering guidance throughout the claims process.
Responsive Call Center Services: Provide prompt, professional assistance through our call center to resolve claims efficiently and enhance the overall service experience.​
Support Coordination: Facilitate timely, accurate communication between members and providers to maintain clarity and minimize delays in claims processing.​
Service Quality Monitoring: Monitor service interactions to ensure accuracy, responsiveness, and satisfaction at every stage of the claims journey.

Reporting &
Data Analytics

Claims Reporting & Dashboards: Provide insights into claim trends, volumes, and financial impact through clear, strategic reporting solutions.
Loss Control & Prevention Strategies: Use claims data to identify patterns, reduce recurring issues, and implement strategies that support improved financial outcomes.​
Operational Insights & Analysis: Utilize reporting tools to measure process performance, highlight inefficiencies, and support operational improvements.
Data-Driven Decision Support: Leverage reporting and analytics to inform strategy, strengthen compliance, and optimize plan performance over time.

Additional
Services

Provider Network Access: Manage relationships with PPO and HMO networks to ensure members have access to quality, in-network care and provider experience.​
Compliance Oversight: Ensure participating providers meet established regulatory and quality standards to maintain network integrity and minimize risk.​
Pre-authorization & Pre-certification: Review and approve procedures in advance to avoid unnecessary treatments and support appropriate, cost-effective care delivery.​
Case Management: Monitor high-cost or complex cases to coordinate care, optimize outcomes, and support effective resource utilization.​

Member &
Provider Support

Member & Provider Communication: Deliver reliable support to members and providers - addressing questions and offering guidance throughout the claims process.
Responsive Call Center Services: Provide prompt, professional assistance through our call center to resolve claims efficiently and enhance the overall service experience.​
Support Coordination: Facilitate timely, accurate communication between members and providers to maintain clarity and minimize delays in claims processing.​
Service Quality Monitoring: Monitor service interactions to ensure accuracy, responsiveness, and satisfaction at every stage of the claims journey.

Reporting &
Data Analytics

Claims Reporting & Dashboards: Provide insights into claim trends, volumes, and financial impact through clear, strategic reporting solutions.
Loss Control & Prevention Strategies: Use claims data to identify patterns, reduce recurring issues, and implement strategies that support improved financial outcomes.​
Operational Insights & Analysis: Utilize reporting tools to measure process performance, highlight inefficiencies, and support operational improvements.​
Data-Driven Decision Support: Leverage reporting and analytics to inform strategy, strengthen compliance, and optimize plan performance over time.

Additional
Services

Provider Network Access: Manage relationships with PPO and HMO networks to ensure members have access to quality, in-network care and provider experience.​
Compliance Oversight: Ensure participating providers meet established regulatory and quality standards to maintain network integrity and minimize risk.​
Pre-authorization & Pre-certification: Review and approve procedures in advance to avoid unnecessary treatments and support appropriate, cost-effective care delivery.​
Case Management: Monitor high-cost or complex cases to coordinate care, optimize outcomes, and support effective resource utilization.​
We are here to assist.
Contact us by phone or email.
© AdminOne. All rights reserved.

AdminOne

About
Services
Contact

LEGAL

Privacy PolicyHow We Use Your Data

CONTACT

For Claims:
(732) 875-7700
claims@adminone.com
For Member Services:
(732) 876-9733
customercare@adminone.com
P.O. Box 21176
Eagan, MN 55121