Employee Satisfaction Through Timely and Accurate Service
PBA adjudicates a full range of claims, including Medical, Dental, Vision and Disability. While the vast majority of our claims services go without notice, there are situations where claims are pended. Some of the more common reasons include: pre-existing condition investigations, requests for certificate of credible coverage, accident information, coordination of benefits (COB) information, financial responsibility information or where we need additional information to properly analyze a claim.

As an example, we may not have the proper diagnosis or codes. The follow up is automated in our system and we generate a second letter where appropriate. When a claim is closed out, the employee is notified with an explanation of benefits (EOB).

If the information was forthcoming, we would then re-open the claim and process it. On large claims that we know will be difficult if delayed, we will try to get the information on the phone with hard copy follow-up documentation.