Our solutions +

You drive what we do. Our flexible, bilingual, white-label business solutions are branded and customized to your specifications. We offer advanced technology, innovative claims management, and administrative services – you choose the combination of products and services that will address your business needs.

One system is all you need

HBM+ business solutions are first and foremost built on technology. And all of our technology is based on the Advantage system. It is a single streamlined system that handles all health benefit categories for claims management and all aspects of plan administration, including:

  • Processing plan member enrolment and information, and benefit plan changes
  • Plan member eligibility
  • Accurate, real-time adjudication for all types of claims
  • Health care provider management, overseeing professional guidelines, fraud and abuse, and regular and customary pricing

  • Claim payments and statements
  • Reporting that can be customized to meet client needs
  • Online services for plan members, administrators and health care providers

Powered by Advantage

Powered by Advantage

HBM+’s automated, flexible, patient-centric, and rules-based health benefits management system completely integrates claims adjudication with administration. This is what we mean:

  • Data (like plan changes, pricing, or provider details) is available in real-time
  • Fully scalable system architecture provides capacity on demand at no additional cost
  • A comprehensive library with thousands of rules can accommodate any plan design
  • Coordination/integration of benefits with provincial drug programs
  • Electronic administration of coordination of benefits claims
  • Plan members can automatically coordinate unreimbursed claim amounts with health care spending accounts

HBM+’s Advantage is the most progressive system in the marketplace today. Our single system offers a patient-centric approach for our flexible, responsive delivery and maintenance of quality benefits management services.

All HBM+ online services - including our mobile applications and providerConnect, our health care provider-specific transactional website, as well as services - are driven by the Advantage system and will enhance the plan member and provider experience.

Capacity on demand, the elimination of legacy systems, reduction in system development and maintenance, and precise compliance with new legislation all contribute to your bottom line.

With an HBM+ solution, you will lower your administration costs, helping you to continue to remain competitive in your market.

At HBM+ developing customized solutions includes reflecting your brand as an integral part of the solution we build with you. Our goal is to seamlessly connect your clients with your organization – not ours.

We deliver business solutions that have the capability to feature your own corporate brand for any or all of these services and tools:

  • ID cards
  • Claim forms
  • Online plan member services
  • Mobile app for plan members
  • Online administration services
  • Reports
  • Online provider services

Outsourcing back-office operations lets you take control of your administration expenses and focus on the things you do best – your core business. HBM+ offers an extensive range of solutions to support benefits administration and claims management – from new business implementation to claims adjudication – for our clients.

The solutions we offer are based on our experience and expertise as a health benefits manager. By understanding your needs, we can develop a solution that will save costs and manage benefits in the most efficient way.

HBM+ is dedicated to the effective management of health care provider records and data.

How? Our provider management solution consists of two integrated components:

  • The providerConnect portal gives health care providers across Canada access to the National Provider Registry, secure services for direct deposit and online claiming, claim forms, administration guidelines, and more
  •  The National Provider Registry is a centralized database of over 280,000 registered health and dental providers authorized to submit claims and/or bill participating carriers directly. It’s updated daily with the provider-specific information required to properly adjudicate claims and to authenticate and certify each health care provider

We also review provider practices and analyze claims data to identify any inappropriate billing patterns, over-use of services, or excessive fees – before they escalate into larger issues.

HBM+ boasts extensive expertise in providing health benefits management and technology solutions to the private and public sectors in Canada.

Our knowledge comes from our people. We hire and retain experienced specialists to develop and maintain our clients’ customized solutions, providing value to your organization and maximizing your success. Here’s what they bring to the table:

  • Solid and proven technology
  • Implementation and project management
  • Account management
  • Pharmacy benefits management
  • Health benefits management
  • Client service
  • Fraud, abuse, and waste management

Customizable based on your needs

Our flexible, white-label business solutions are branded and customized to your specific needs. You choose the combination of products and services that will fit your business needs. Here are just two solutions we provided to clients that had very different requirements.

Claims adjudication and online services

Client requirements:

  • Claims adjudication technology scalable to meet long-term growth objectives
  • E-services for plan members and providers
  • Support complex transition from current technology solution
  • Maintain excellent relationships with providers
  • Enhance visibility of client brand among plan members, administrators and sponsors

How we responded:

  • Implemented Advantage: cloud-based, enterprise-wide claims adjudication and benefits management solution
  • Elimination of legacy systems
  • Branded self-service solutions for plan members and health care providers
  • Access to ongoing product innovations
  • Long-term cost certainty and predictability
Outsourced and branded service team

Client requirements:

  • Fully outsourced and branded administration, claims adjudication, call centre services, and plan member website
  • Single system for all benefit lines to ensure the highest level of accuracy, data integrity, and administrative efficiencies
  • Minimal capital investment
  • Service delivery team that could support a national block of growing business

How we responded:

  • Branded back office operational team to manage eligibility and billing, adjudicate health claims, and provide call centre services to plan members and providers
  • Leveraged capabilities of the Advantage system
  • Access to expertise, innovations and industry best practices
  • Long-term cost certainty and predictability