WHAT IS JCA?
JCA stands for Joint Claims Administration. JCA is a health care delivery system that combines the talents and expertise of a number of successful health care delivery systems and organizations into a single comprehensive, efficient “state of the art” delivery system. This combination produces synergy that provides the “best in practice” in health care benefits.
It has already been said by a number of health care experts regarding the status of the current health care crisis it has been said “Today, It doesn’t matter how we got here, but the only way out is for management, labor, and the insurance industry to working together on a strong, long term viable solutions”. JCA is a strong viable solution for many employer/employee groups where many a number of reputable health care organizations have come together who are committed to drive change into our the current health care delivery system so that it will provide better care at a more affordable and effective price. Listed below are those committed organizations, and the roles each of these organizations will play in the Joint Claims Administration Program:
- Aetna Health – Aetna Health is one of the largest national health care insurers in the US. Aetna brings to the table high tech web based employer/employee tools designed to provide the best in practice in heath care. Aetna also brings a strong nationwide PPO provider network which is continuously updated, as well as “state of the art” chronic and disease case management services. Aetna’s role in JCA is to accept all member claims, (in par and out of network non par) price them according to their network agreements and electronically forwarding them to BPA for processing and adjudicating.
- Associated Mutual (AMHI) – Associated Mutual’s role is to provide an entire menu of insurance and reinsurance options. AMHI also provides the Family Security Voluntary Options Programs as well as other employee life and disability program needs. Associated Mutual also provides the prescription drug component on either a self funding or on an insured basis.
- Benefit Plan Administrators (BPA) – BPA accepts re-priced Aetna PPO Claims (PPO Claims) from Aetna and adjudicates them according to the employer’s and/or associations plan document. Once the claim has been adjudicated, it is wired back to Aetna and Aetna then pays the provider and/or facility. BPA will provides an Explanation of Benefits Statement (EOB) to the covered member, and also pays any and all non-assigned claims.
BPA will also provide the group with the necessary HIPAA compliant claim reports, etc.
Lastly, BPA will provide the employer and/or association with all employee eligibility maintenance and customer service (on site, telephone, and email) to the group and/or association.
- Organized Labor – For this concept to be successful organized labor needs to support this process, and therefore to be eligible for JCA; the employer must have an organized labor bargaining unit within their employee group. Organized labor needs to support this process and educate its leaders, locals, and members on the value of the JCA delivery system.
- Associations and Employers - The employer and/or association are responsible for maintaining and collecting benefit plan data that is provided by BPA. With the assistance of team members BPA, Aetna, Associated Mutual, and consultants (if applicable) will work closely with labor to determine what future roads need be to followed to create the necessary plan stability to that will meets the goals of both Management and Labor.
In summary, JCA is a refreshing and unique approach to which addresses health care plan issues with the most current “cutting edge” techniques and services that will provide your employees and/or members with:
The Right Service & Treatment
At the Right Time, and
At the Right Price
HOW DO I FIND OUT MORE ABOUT JCA?
You can find out more about JCA by contacting Associated Mutual:
5800 Foremost Drive
Grand Rapids, Michigan 49546
Telephone – 888-808-0408
Email – Jjacobitz@amhsm.com