Claims Administration

We are an industry leader in benefits administration because unlike most TPAs, we have both experienced examiners and nurses working together under one roof. Our unique, coordinated approach saves our customers an average of 59% off 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.

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.  Legitimate, clean claims are paid on your behalf. 

Claims administration also comes 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.

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

  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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