Software Solutions and Technology

Claims Health Care Processing System (HCPS)

Pinnacle is unique in that we have our own Information Technology (IT) division.  Our Health Care Processing System (HCPS) architecture ensures that modifications and improvements can be made easily and quickly. When benefit plans change, we have the capability to make changes promptly, providing outstanding service and cost management.

Housed at our headquarters, Pinnacle's Health Care Processing System (HCPS) helps us process claims in less than seven days. Providers are paid quickly, the employee receives up-to-date information on their health care bills, and our clients receive weekly reports from Pinnacle.

Our system also takes advantage of the latest Web technologies to deliver health, benefit, and claim information to your employees in a secure, HIPAA-compliant environment. Three Web based products that we provide are: Web Employee Eligibility System (Web EES) for Employers, Online Provider Information System (OPIS) for Providers and HealthView for employees.

Web Employee Eligibility System (Web EES)

Web EES integrates with the HCPS to allow client employers to maintain their own employee benefit eligibility information.  Employers using Web EES can update eligibility information in real-time through the Internet at their own convenience.  The system improves the efficiency and accuracy of health care claims processing, providing an enhanced benefit to employees and their families. Employers can enroll, terminate, change and view status of employee eligibility and make changes real time. This application also allows the employer to run various reports based on the respective data. Pinnacle packages online convenience with customer care. 

Online Provider Information Service (OPIS)

Pinnacle allows health care providers the option of bypassing our Customer Service Department by accessing information directly online. The Online Provider Information Service (OPIS) allows providers to access eligibility, deductible, claim status, and plan specifications information 24 hours a day, 7 days a week. This service is provided free of charge. Equipment requirements include a personal computer with dial-out capabilities. Pinnacle's Information Services Department is available to assist providers with the initial set-up of their computer. Local and toll free numbers provide easy access, and an OPIS guide provides step-by-step details on how to retrieve data.

HealthView

HealthView integrates with the HCPS to allow online access for plan participants to view their health care benefits information.  Plan participants include employees and their covered dependents that are eligible for health care benefits. This includes provider lookup, member profile, claims status, e-mail customer service, change address and request new ID cards, among other features. 

For more information regarding Web EES, OPIS or HealthView please contact Pinnacle's Administration Department.