BENEFITS ADMINISTRATION - PRIVATE LABEL

Network Management: 

• The network management function primarily involves assigning dentists to dental offices for listing purposes and adjudicating claims. 

• Dentists and dental offices may be sourced and “stacked” from various networks according to carrier preference, including the carrier’s proprietary network (featuring local and regional contracted dentists), DigiBite’s contracted dentists, third-party lease networks (such as GRID Blues Network and others), DigiBite’s leased network A, and DigiBite’s leased network B, among others in a stack preferred by partner by LOB. 

• Furthermore, DigiBite can manage the proprietary network or GRID network on behalf of the carrier.

Credentialing – Real-Time Pass/Fail 

• Use Robotic Process Automation (RPA) and AI to do primary source verification and ongoing monitoring of sanctions for all healthcare providers in compliance with NCQA standards.

• Process: Dentist applies online, immediate credentialing for pass/fail and if pass contract is accepted, dentist is activated and dentist appears on the online dentist search in a matter of minutes.

• Custom client credentialing and contracting rules and standards can also be implemented.

On-line Access and Web Portals - Private Label Single Sign On

• Client - Client can access real-time KPI reports through Group Admin module, modify and upload eligibility, pay off of list bills.

• Member: Member Portal – Members can view plan information in plain language (e.g., benefits, waiting periods, dates) and make updates to communication information (e.g., address, e-mail address, phone number) across different product types (e.g., dental, vision), search for providers, view claim status, claim Explanation of Benefits and FAQ’s.

• Provider: Self-service provider portal to apply for services, check eligibility and benefits, submit 
  claims, update office locations and providers information, update and verify provider directory, Manage 
  local office(s) security access,

Customer Service 

•  Our AI virtual agents and chatbots can answer >50% of table-stake calls on eligibility, claim status and payment status

• Reduce overall call center costs by 50%, while reducing provider call costs by more than 75%

•  Custom hours for live agents by LOB.

• KPI standards met with financial performance guarantees 

Tailored Experience 

• Each implementation is based on clients needs and preferences

• All eligibility, billing, group plan, provider management, claims, and reporting is API driven for immediate onboarding and continual updates

DigiBite can also provide additional benefit admin services, such as:

• Consolidated billing 

• Vision benefits (ask us about our national network) 

• Billing and processing of Life, DI, and other services 

• Fraud, Waste and Abuse

Security

• HIPAA – all security and information access protocols follow HIPAA standards. All frequency reviews are followed, recorded and tracked. An annual compliance review is also conducted. This is for all aspects of data collection, processing and storage for each stage of business operations.

• SOC2 – Our operating software is SOC2 compliant with annual reviews.

• HIPAA / HITRUST - Our operating software is currently going through a HIPAA/HITRUST certification – Expected Summer 2025

• All security access, changes, eyeballs and clicks are tracked and monitored.