Whether you’re an employer, plan participant, broker, or provider, you have secure access to our proprietary technology and online tools to retrieve health benefit information. Our online tools allow access to reports, updates to profile information, eligibility and enrollment, and secure payments.
PERC is a free tool available to our brokers and 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 specific needs of our brokers and employers, our proprietary online health benefits tool can be customized to provide access to the information and reports you need most.
We help make managing your employee benefits a little 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.
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.
OPIS allows health care providers direct access to patient information via this convenient online tool. Providers can look up eligibility, deductibles, claim status, benefit plan information and more so that they do not have to call customer service to obtain such information.
OPIS is offered to providers free of charge and is available 24 hours a day, seven days a week through our interactive intelligence phone system (IVR).
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.
Electronic Claims
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.
HIPAA Compliance
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.
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.
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