Proprietary Processing Technology
Health Claims Processing System (HCPS)
Our experienced team conducts all claims administration services onsite. You can count on accurate and cost effective claims processing with our state-of-the-art proprietary Health Claims Processing System (HCPS). We have regional claims processing and service centers in Irvine and Fresno and have direct oversight to review calls, audit claims and routinely check for accuracy. SSAE Type I and Type II compliance reports verify our company is meeting the highest industry standards to offer you the best in quality service and performance.
We receive over 90% of our claims through an electronic data interchange (EDI), which allows us to automatically process claims based on your specific plan. Our claims examiners review each submission to identify any potential errors and address special circumstances requested by the client. We electronically transmit eligibility and claims information daily, allowing for quick payment.
The Health Insurance Portability and Accountability Act (HIPAA) was created to protect your personal information and privacy. We adhere to industry standards for transmitting, utilizing, disclosing and safeguarding confidential medical information to ensure compliance.
Field Service Inquiry Tool
Our proprietary Field Service Inquiry Tool enables our field service representatives to access our systems and document services and activities while they are out in the field. The tool provides a snapshot of all the services provided for both employers and employees from each field office and for every assigned field service representative.
The tool gives us the ability to generate reports for employers on all documented information regarding hours of service provided, field visits, emails, calls, and even travel time. This enables Pinnacle to identify consistent patterns on issues that include eligibility, claims, or deductibles.