Customer Care & Claims Administration
Claims Administration
All of our claims administration services are conducted on-site by our experienced team. And with our state-of-the-art proprietary claims processing system, you can count on accurate and cost effective claims processing.
Electronic Claims
Over 90% of our claims are received electronically through electronic data interchange (EDI). This allows us to automatically adjudicate claims based on your specific benefit plan. Our claims examiners review claims as they are adjudicated to pinpoint any potential errors, or address special circumstances requested by each client.
Eligibility and claims information is electronically transmitted daily, allowing for quick turnaround of payments.
Performance Standards
We strive to exceed your expectations and commit to aggressive claims processing performance standards.
HIPAA Compliance
We commit to industry standards for transmitting, utilizing, disclosing and safeguarding confidential medical information to ensure HIPPA compliance.
Online Tools
Whether you’re an employer, plan participant, broker, or provider, access the health benefit information you need on demand, using our proprietary online tools.
Customer Service
We know that dealing with health care issues can be stressful for employees and their families. That's why we have friendly and supportive people answering calls. Our bilingual customer service representatives are dedicated to each client. That means representatives are knowledgeable about your individual health plan and can give accurate, timely, and personalized information. We track performance standards and quarterly reports are always available to our clients.
Mon-Thur, 7 a.m. - 5 p.m.; Fri 9 a.m. - 5 p.m.
800-649-9121
customerservice@pinnacletpa.com
Information is also accessible 24 hours a day via touch tone phone using our Interactive Voice Response (IVR) system.
