With a self-funded plan managed by Planned Administrators, Inc., companies can enjoy greater flexibility, efficiency, and reduced costs. PAI’s third party administrator (TPA) services can include:

• Customer Service: to answer plan related questions and provide the tools needed to understand your plan dashboard. 
• Case Management: engaging members and developing a plan of care specific to their needs and set up goals to promote quality and cost-effective outcomes. 
• Claims Administration: integrated with a claims management system, our member, provider and agent portals allow for access to vital information. 
• Benefit Reporting and Analytics: on claims, members and other metrics for benchmarking and plan performance analysis. 
• Stop-loss Insurance Placement: to help protect employers from the financial risk of catastrophic claims  
• Utilization Review: to manage overall medical spending and provide early notifications for potentially higher-cost claims. To ensure proper pre-certifications, notifications, and approvals are in place, and medical polices and clinical practice guidelines are up-to-date.
• PPO Network Access: to provider networks.
• Expense Reporting: to understand costs and propose wellness programs or incentives to reduce costs.
• HIPAA and Regulatory Compliance Assistance: to help determine how changes apply to health plans and implementation.
• Lower Administrative Costs: to streamline administrative processes and help ease many common pitfalls of benefit enrollment changes.
• Pharmacy Benefit Management (PBM) to Provide Services: that create smarter healthcare connections to help your members realize improved care and lower costs.
• Provider Web-Portal: with real-time claim submission and inquiries into claim status and member eligibility. This promotes provider self-service and increased access to information needed to continue serving members.  
  • Member and Client Web-Portal to:
  • Find a network provider
  • View plan document and benefit summaries
  • Access claims and Explanation of Benefits
  • Print, view, share or request an ID card
  • Access pharmacy benefits
  • Access forms
  • View member discounts and value-add programs
  • Email Customer Service

Contact us to see if we can help.

‘The greatest “product” advantage TPAs have is flexibility and personalized service. Every TPA-administered plan is custom-designed for the plan sponsor’s needs and specific workforce.’– Fred Hunt, past President, Society of Professional Benefits Administrators (SPBA)