Claims Administration

Since the company’s inception, our claims administration has been supported by the clinical expertise of our in-house nurses. This unique approach has made us an industry leader with an accuracy rate of 99.8%. Better still, our customers only pay an average of 59% of submitted claims charges. We have had multiple customers experience a 0% increase in claims costs, year over year, due to our combination of solid claims management and innovative wellness programs.

Direct customer service is part of our claims administration too, a favorite feature among plan members and HR departments. When a plan member has a question, they can speak one-on-one with the person who handled the claim from the start.

At Prairie States nurses audit every claim over $5,000 to ensure that inappropriate, duplicate and fraudulent bills are not paid. We also use a software module to confirm and verify the results of these efforts. Only legitimate, clean claims are paid. 

We have one of the fastest turn-around times, averaging 5.4 days versus the 14-day industry standard. Claims administration is also fully integrated with our wellness programs. This allows us to identify plan members who could benefit from care earlier rather than later. That in turn results in a better health outcome for the member and significant cost savings all around.
  Performance Guarantees
  • All calls answered in an average of three rings by a real person during business hours.
  • All clean claims paid in less than 10 days.
  • 99+% financial accuracy rate.
Or you receive a 10% fee rebate.
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The perfect choice for small businesses that want to move away from fully insured plans.
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