Prairie 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 is only part of the story. Prairie States’ ability to work closely with health care providers to improve care is what really sets us apart.
Health management insight in patient claims administration
Prairie States is easier for providers to work with than other TPAs because we combine claims administration with proactive, intelligent health management solutions. Our highly trained Registered Nurses have thorough knowledge of provider best practices and health management procedures. By applying their expertise to patient claims administration, they can quickly verify if claims are accurate so that providers can be paid promptly.

Our claims administration staff delivers personalized service
Prairie States delivers a level of service satisfaction you won’t find elsewhere. Our claims processors perform their own customer service – there’s no separate department. When a provider or patient 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 administration organization they’ve ever used. Everyone mentions the extraordinary customer service as one of the best advantages of working with us!
Dental Claims Administration
Prairie States offers exceptional service in dental claims administration. Dental claims are processed by health management personnel with dental experience. As with medical claims administration, our dental claims examiners respond directly to your employees' claim inquiries and related questions. We also have Dental Preferred Provider Organizations available to provide discounted services.

Vision Claims Administration
All of our customers offering vision care in their benefit plan have chosen Prairie States to provide claims administration for their vision plan. We partner with our PPOs to create vision plans that provide services to our customers at favorable rates.

COBRA and HIPAA Certifications and Claims Administration
Most companies 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 claims administration 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 Claims Administration
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 our customers 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 finds savings in health management claims
Prairie States' proactive intervention has delivered 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 employers to either fully or partially avoid losses through preemptive loss transfer techniques.
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