Claims Administration

Pinnacle provides superior claims administration services to self-funded, employer-sponsored benefit plans.  With our state-of-the-art, Health Care Processing System (HCPS), we process health care claims in an accurate, prompt, and cost-effective manner. As a third-party administrator, our services include claim adjudication of the full array of health care claims, as well as Coordination of Benefits (COB), subrogation, Explanation of Benefits (EOB) and benefit checks, network repricing, and quality assurance oversight of all processes. Pinnacle is HIPAA-compliant with Electronic Data Interchange (EDI) transactions, and our services are performed in an office environment that meets or exceeds HIPAA's regulatory standards. We have a Regulatory Compliance staff to ensure compliance with federal and state statutes. Pinnacle is licensed as a third-party administrator (TPA) in California, Arizona, Nevada and Texas. Our corporate headquarters provides a safe and secure environment for your claims administration services. Our building is locked 24 hours a day, seven days a week, with access provided only to employees or authorized visitors. Every aspect of our claims administration services is performed on-site. No TPA functions are outsourced to an external entity. All Pinnacle employees adhere to strict policies protecting the privacy and confidentiality of your company's health records and data.