Claims Administration
Premier Network, Stop Loss & PBM Partners
Claims Cost Containment & Payment Integrity
Data Analytics & Reporting
Proprietary Technology
Compliance & Performance Standards
Premier Network, Stop Loss & PBM Partners
BRMS provides access to local and national PPO networks, assisting in the placement of traditional and captive stop loss contracts while also offering pre-negotiated pharmacy benefit contracts.
Claims Cost Containment & Payment Integrity
BRMS provides hands-on, in-house claims cost containment solutions designed to reduce spend while maintaining compliance and accuracy. Our services include high-dollar bill reviews, claims editing, subrogation recovery, and out-of-network claims savings strategies. We adhere to No Surprises Act (NSA) regulations and apply rigorous review processes to help ensure fair, accurate payments and maximize savings for our clients.
Data Analytics & Reporting
BRMS empowers employers to make informed decisions on their health plans through access to high-quality data and reporting. Our platform gives a 360- degree view of claims utilization with insight into clinical rusk and gaps in care.
Proprietary Technology
Efficiently manage your benefits through BRMS’s proprietary claims and reporting system, along with benefits administration powered by MyHealthBenefits. Our advanced claims systems support accurate, timely claims processing, streamlined workflows, and enhanced payment integrity to help improve operational efficiency and control costs. Our best-in-class online tools simplify benefits enrollment, access to plan information, claims submission and reimbursement, and life event management, creating a seamless experience for both employers and members.
Compliance & Performance Standards
Gain peace of mind through BRMS’s commitment to the highest standards of compliance, security, and operational integrity. Our internal controls and processes support SSAE Type I and II audits, SOC 2, and HIPAA compliance requirements, reflecting our dedication to protecting client, member and vendor information. We remain at the forefront of evolving industry regulations and legislation to help ensure ongoing compliance excellence.
For over 3 decades, BRMS has provided expert claims administration solutions backed by proprietary claims and eligibility systems, experienced claims examiners, and a dedicated in-house care management team. Unlike automated processing models, every claim at BRMS is reviewed by a claims examiner, eliminating auto-adjudication and ensuring a human element is applied to every claim decision for greater accuracy, consistency, and member advocacy. Through premier partnerships with leading carriers and innovative point solution vendors, BRMS seamlessly integrates programs and services directly into our platform to create a more connected and efficient experience for both clients and members. By combining advanced technology with personalized service and decades of industry expertise, BRMS delivers scalable solutions focused on efficiency, cost containment, and exceptional support
Care Management
The case management team was extremely helpful in getting me my much needed medication.
They helped me navigate the never ending rabbit hole that is the insurance process, and were able to get my medications much faster than if I was left on my own. I would not be on the road to recovery if with wasn’t for the [BRMS] managed care group”
- BRMS Plan Member
Utilization Review
Disease Management
Point
Solutions
Pharmacy Advocacy
Case Management
Utilization Review
BRMS’s specialized team of registered nurses reviews inpatient and outpatient services to help ensure care is medically necessary, clinically appropriate, and delivered at the optimal level of care. Through concurrent review, discharge planning, and coordination of care, our nurses help improve outcomes while supporting cost-effective treatment decisions. The team also guides members to in-network providers and proactively identifies opportunities for early intervention and enhanced care management.
Disease Management
BRMS Members with chronic conditions are identified through an advanced predictive modeling system and once enrolled, work one-to-one with a dedicated nurse health coach.
Point Solutions
MyHealthBenefits enables seamless integrations and the application of additional cost containment solutions tailored to our clients’ health plans. With our integrated technology solutions we can monitor plan spend and identify members with chronic conditions to support proactive care management and improved outcomes. We partner with leading cost containment solutions for MSK care, telehealth, chronic condition management, and other specialized programs designed to enhance member care while helping control costs.
Pharmacy Advocacy
BRMS partners with comprehensive programs through our PBM consultants, Navion, to address complex pharmacy challenges, including oversight and support for high-cost and specialty medications. Our optional service features include management strategies for advanced therapies such as gene and cell therapies, as well as GLP-1 medications, helping ensure clinically appropriate utilization and cost-effective care.
Case Management
BRMS helps members navigate complex healthcare needs while promoting quality outcomes and cost-effective care. Led by experienced clinicians, we provide coordinated support for large and complex cases, behavioral health services, and specialty conditions including oncology, transplants, neonatal care, cardiac care, high-risk pregnancy, and more. Through ongoing oversight, care coordination, and proactive intervention, we help ensure members receive the right care at the right time.
Dental + Vision
BRMS offers flexible, cost-effective dental and vision administration solutions that provide employers with a smart alternative to traditional insurance. Through national and regional networks, employees gain access to quality care, valuable savings, and a streamlined benefits experience designed to maximize benefit dollars and simplify administration.
Dental Administration
Vision
Benefits
Dental Administration
BRMS provides a solution that is an affordable, self-funded alternative to employer-sponsored dental insurance, covering all levels of standard dental care. Access national, regional networks or open access dental benefits in partnership with our expert claims administration system and team.
Vision Benefits
BRMS offers Vision Administration with a focused, flexible approach and no restrictive network requirements. Through our “Direct Vision Reimbursement” program, employees have the freedom to choose the eye care provider that works best for them - whether that’s a trusted local optometrist or a preferred national retail chain. The choice is entirely theirs.
Access custom pharmacy benefit contracts and solutions through BRMSRx. Our veteran experience combined with data-driven decision-making produce an average of 30% savings that can be reinvested in your business.
Choice
Over 200 potential savings combinations.
Leverage
Strength and negotiating power through our large network.
Savings
Advisory services to drive down cost and mitigate Rx spend.
Data Analytics & Reporting
Data Analytics and Reporting offers innovative ways to analyze healthcare data from both the clinical and financial perspective. Our analytics platform combines plan data, rich visualizations, and quality comparison and benchmarking to allow recipients to make data-driven decisions to help achieve their financial goals.
Plan
Analytics
Executive Analytics
Plan Analytics
BRMS provides easy access to robust plan reporting and analytics used by our Client Management and Care Management teams to monitor performance and outcomes. Our data-driven insights help track key plan metrics, identify trends, and support proactive decision-making to improve cost, quality, and member experience.
Executive Analytics
View a high-level Executive Analytics dashboard through BRMS that delivers clear visibility into key financial and utilization trends across your health plan. Designed for plan sponsors, CFOs, and HR executives, it provides actionable insights into cost drivers, claims activity, and overall plan performance.