•   Clear exclusion language
  •   Experimental/Investigational definition based on both commercial as well as Medicare standards
  •   In vs. out of network benefit structural elements
  •   Preventive service levels detailed and defined
  •   Cosmetic vs. reconstructive vs. medically necessary elements
  •   Continuation of coverage and extension of benefits
  •   Benefit overrides and one time plan exceptions
  •   Custodial vs. skilled care definition
  •   Drug review: formulary, off-label and FDA-approved
  •   Behavioral health: substance abuse and mental health
  •   Emergency vs. urgent vs. non-urgent care
  •   Hospice, home health benefit structure
  •   Therapies: physical, occupational, speech and chiropractic
  •   Coordination of benefits

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HealthClaim Solutions® is a Considine & Associates Inc. company that provides health benefit design services to employers in the manufacturing and service sectors to assist in the processing and review of medical claims and billing. HealthClaim Solutions® provides software reporting capabilities that are designed to be client specific and user directed.


HealthClaim Solutions® services are centered on the development and ongoing innovation of hardware to maintain the proprietary cloud and the design of a web-based software application to assist in the administration of health benefits and payment of medical claims by clients. Software claims payment solutions provide intelligent algorithmic medical claims review and evaluation. The software component of the business is provided using Linux-based secure web portal that meets stringent HIPAA Health Privacy Standards. These solutions are provided to clients using secure cloud web services that originate from an on-site information technology nexus.

BENEFIT PLAN DESIGN AND DEVELOPMENT SERVICES