We Simplify Health Benefits Administration

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Custom Health Benefits Solutions to Fit Your Needs

Pinnacle handles your unique administration requirements and enables you to avoid the hassle of unnecessary paperwork.

We place tremendous value in the relationships with our clients. Our goal is to help you find the most comprehensive, cost-effective self-funded benefit program that matches the needs of your organization.

We house all of our services internally, and work with proprietary systems that enable us to customize services and reports, and handle inquiries as efficiently as possible. We’re also one of the few TPAs with a co-location and, we run complete annual disaster recovery training, so you can rest assured that we’re capable of operating seamlessly and throughout the most difficult of times.

Health Benefits Administration

Let us simplify your health benefits administration with personalized plan designs, competitive network solutions, innovative cost management programs, and integrated disease management and wellness options that fit your needs and budget.

We’re Experts in:

  • Benefits Administration
  • Claims Administration
  • Eligibility & Enrollment
  • Customer Service

 

We’re Experts in:

  • Benefits Administration
  • Claims Administration
  • Eligibility & Enrollment
  • Customer Service
  • Health Care Networks
  • Health Management
  • Cost Management
  • And Much More…

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  • Health Care Networks
  • Health Management
  • Cost Management
  • And Much More…

Online Tools

Our Employers have secure access to our proprietary online tools to retrieve health benefit information. Our online tools provide access to reports, updates to profile information, eligibility and enrollment, and secure payments.

PERC

PERC is a free tool available to our employers to easily access and update their health benefits information. We offer one-on-one program training so you can begin accessing your plan information immediately and understand how to maximize all that this resource has to offer.

Driven by the unique needs of our employers, our proprietary online health benefits tool can be customized to provide access to the information and reports you need most.

Key capabilities include:

  • Update and add employee information
  • Terminations on an individual basis or multiple terminations
  • View claims details and status
  • Request duplicate explanation of benefits (EOBs

 

Key capabilities include:

  • Update and add employee information
  • Terminations on an individual basis or multiple terminations
  • View claims details and status
  • Request duplicate explanation of benefits (EOBs)
  • Generate detailed reports
  • Print temporary ID cards
  • Query reports for in depth health benefit data analysis
  • Review employee eligibility history
  • Generate detailed reports
  • Print temporary ID cards
  • Query reports for in depth health benefit data analysis

HealthView Online for Plan Participants

We make managing your employee benefits easier by giving your employees convenient access to their health benefits information via a secure, easy-to-use online tool. HealthView is a free tool available 24 hours a day, seven days a week. Empower your employees to stay in control of their health benefits with this online tool.

With HealthView, employees can:

  • Look up claims status and history
  • Order a replacement ID card
  • Review explanation of benefits (EOBs)
  • Look up providers

With HealthView, employees can:

  • Look up claims status and history
  • Order a replacement ID card
  • Review explanation of benefits (EOBs)
  • Look up providers
  • Download forms
  • Search within a plan document
  • Email customer service
  • Update contact information

 

  • Download forms
  • Search within a plan document
  • Email customer service
  • Update contact informatio

 

Online Enrollment for Employees

By eliminating paper forms, we simplify the enrollment process with easy, online enrollment. The online enrollment application enables employees to make their own health benefit elections via a convenient and secure online form.

Key capabilities include:

  • Selecting benefit plans based on employee eligibility criteria
  • User friendly, online screens that guide employees through the open enrollment process from start to finish
  • Real-time employee updates such as: change of address, marital status, dependent information, and dependents status
  • Links to provider websites
  • Review of company-specific plan documents
  • Election of voluntary, optional products

Provider Tools

Your employees want quick and easy processing when they visit their doctor. Our Online Provider Information System (OPIS) speeds up front office paperwork. This simple to use online tool allows health care providers instant access to patient eligibility, deductibles, claim status, benefit plan information and more.

Predictive Modeling, Benchmarks and Analytics

Pinnacle offers comprehensive reporting to provide direct oversight to help you take control of your health care dollars. Our state of the art reporting solutions, allow health benefit managers and brokers to conduct health trend analysis from an easy-to-use, web-based platform. We work with you to tailor programs that maximize appropriate utilization and generate the most cost-effective benefit solutions.

By evaluating your analytics, you can:

  • Learn more about the health of your workforce
  • Understand the true benefits of your plan and wellness strategy
  • Pinpoint chronic health conditions
  • Develop a better understanding your employee population

Customer-Centric Approach

We have more than 20+ years of experience in delivering exceptional service. Pinnacle handles your unique administration requirements and enables you to avoid the hassle of unnecessary paperwork.

We Offer:

  • Bilingual service
  • Fast and accurate claims processing
  • Dedicated account managers
  • In-house service representatives
  • HIPAA compliance
  • Regulatory and compliance assistance

One-Stop Solutions

In addition to third-party administration services, we provide you with a full-suite of customizable solutions to match your comprehensive health benefit needs. You can customize your solutions, or we can seamlessly integrate with your vendors.

Our comprehensive offerings enables employers to avoid having to work with multiple vendors. We also have the flexibility of seamlessly integrating our solutions with your vendors.

 

Customize your experience by choosing the solutions you need:

See what Pinnacle can do…

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