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Claims
Administration
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Medical Claims
AdministrationPrairie
States’ track record for processing medical claims
promptly and accurately is the best in the industry.
Independent audits show turnaround times of three to
five days with an unheard of accuracy rate of 99.8%!
But paying claims quickly, with precision, and in
accordance with the plan is only part of the story.
Prairie States’ cost-savings strategies are what really
set us apart.
Prairie States finds savings our
competitors don’t because we combine claims
administration with proactive, intelligent health
management solutions. For example, our highly
trained registered nurses audit
every inpatient and outpatient hospital bill,
checking for inappropriate, duplicate, and/or fraudulent
charges. On average, our nurses’ audits collectively
save our customers over $160,000 a month!
Our customers enjoy a level of
service satisfaction they won’t find elsewhere.
Our claims processors perform their own customer service
– there’s no separate department. When a plan
participant has a question, he or she speaks directly
with the person who handled the claim from the start.
Prairie States’ customers rate us the best claims
organization they’ve ever used. Everyone mentions
the extraordinary customer service for employees and
their families as one of the best advantages of working
with us.
Dental Claims Administration
Prairie States Enterprises offers
exceptional service in dental claims administration.
Dental claims are processed by personnel with dental
experience. As with the medical claims administration
model, the dental claims examiners also serve as the
customer service link to respond to claim inquiries and
related questions. Dental Preferred Provider
Organizations are available to provide discounted services.
Vision
Claims Administration
All of our customers offering vision
care in their benefit plan have chosen Prairie States to
administer the vision plan. We partner with our customers to
create vision plans that provide services at discounted
rates.
Health Savings Accounts
(HSAs) and Health Reimbursement Accounts (HRAs)
Prairie States offers administration of
health benefit plans that include HSA, HRA and Flexible
Spending Account options, or any combinagtion of these
features. With one of the nation’s leading legal
experts on retainer, Prairie States has a thorough
understanding of these rapidly evolving programs, permitting
us to consult with and advise our customers of the latest
trends and changes in regulations.
Flexible Spending Accounts
with Autoflex
Prairie States offers complete Section
125/129 administration, including plan documents.
Through the Autoflex feature, Prairie States automatically
issues Flex checks to members for healthcare claims amounts
not covered, such as deductibles. Prairie States provides
confirmation statements, forfeiture reporting, salary
deduction data, and reimbursement checks for employees.
Participants may check all aspects of their Flex account
balances and payments on-line 24/7.
COBRA and HIPAA Administration
Most clients who use Prairie States to
process their medical and dental claims also ask us to
manage their COBRA program. Administered efficiently
and in an automated environment, our COBRA administration is
a complete turnkey solution. We constantly keep up with
legislative changes so that every letter and notice we send
is in complete compliance with the current Federal
regulations. In addition, any customer contracting
with us for COBRA administration also receives complete
HIPAA compliance service, including investigations and
certificate generation.
Short Term Disability
Many self-insured employers self-fund
their short term disability plan as well. Prairie
States administers the short term disability claims in
accordance with wage scale formulas, or any other method
used to determine payment. We carefully track every
disability case, advising you monthly on the status of all
cases. Registered nurses regularly review each case to
ensure the continued need for short term disability leave.
We coordinate our efforts with the light duty and
return-to-work programs. Short term programs are
administered in conjunction with the self-funded plan and
long-term programs that may be fully insured or
self-funded.
Subrogation
Prairie States' proactive
intervention has meant a proven record of subrogation
savings, ranging from 3%-6% of paid claims, far superior to
the industry average of 1%-2%! We are actively involved at
the very front end of the claims adjudication process,
enabling clients to either fully or partially avoid losses
through preemptive loss transfer techniques.
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Chicago, IL
