The core of all TPAs but where PBA differentiates itself.
Creative Plan Designs
We can administer many types of plan designs; including narrow networks, direct contracts, or tiered plan designs with concierge services to drive steerage.
Medical Bill Review
Review every claim with a goal of verifying the appropriateness of the services billed and compliance with national billing code standards.
PBA achieves an average discount of 58.1% on 98% of out-of-network claims.
Selective Auto Adjudication
To maximize plan cost control, we place every claim on hold pending Claim Analyst review if it is over $10,000 as well as all hospital services, services requiring pre-certification, services resulting from potential third party liability, or high cost drug claims.