Claims Administration Simplified

As an industry-leading third-party administrator (TPA), Prairie States partners with employers to administer their health plans with clinical expertise and compassion. You’ll appreciate the way we process your medical, dental, and vision claims quickly and accurately.

Personalized Services

When members have questions, they can speak directly to their dedicated Prairie States team. No long wait times, inconsistent answers, or confusion regarding your health benefits.

97+%

First-call resolution rate

Health Management & Wellness

Here at Prairie States, our members come first, and that extends beyond our exceptional level of customer support. We offer a variety of health management, wellness, and concierge programs that not only encourage members to stay healthy but also help them navigate the complexities of the healthcare system.

  • Utilization Management
  • Case Management
  • Condition Management
  • Vitality Essentials Wellness Program
  • FiveStar Health Concierge Service
Health & Wellness

Flexible Spending Accounts and Health Reimbursement Accounts

Flexible Spending Accounts (FSAs) and Health Reimbursement Accounts (HRAs) allow members to pay for routine healthcare expenses directly from an account funded with pre-tax dollars.

Through our member portal and app, members can sign up for direct deposit, request reimbursements, upload receipts, view balances, and more.

Convenient payment options are available depending on the employer’s plan:

  • Manual reimbursement submission
  • Auto-Flex with automatic payment at time of service
  • Benefits Card for payment like a debit card
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Member Portal & Mobile App

Through our online member portal and mobile app, members have streamlined access to claims and plan information.

  • View benefits and healthcare claims
  • Track deductibles and out-of-pocket balances
  • Find providers
  • Download temporary ID cards
  • Access forms and EOBs
  • Send secure messages to our team
Access Member Portal

Once members are registered in the member portal, the same great features can be accessed through the Prairie States Enterprises mobile app!