BCBS South Carolina company to process TRICARE claims

March 19, 2012 in Medical Technology

FLORENCE, SC – PGBA, a BlueCross BlueShield of South Carolina subsidiary company has been awarded a new contract by UnitedHealth Military and Veterans Services (UMVS) to help process TRICARE claims.

TRICARE is the U.S. military’s health care program for active-duty and retired service members and their families.
 
PGBA, based in Florence, S.C., announced March 16, it would process TRICARE claims and provide claims-related customer service and sophisticated systems platforms, integrated with UnitedHealth Group systems, on behalf of beneficiaries, physicians and hospitals as a subcontractor to UMVS.

[See also: DoD enlists Epocrates for TRICARE formulary access]

UMVS, a UnitedHealth Group company based in Minneapolis, was awarded the TRICARE Managed Care Support contract to provide medical and referral management, care provider networks, customer service and claims processing, as well as management support including cost trend risk management, fraud and abuse detection, and quality management services in the West Region of the United States.
 
PGBA already performs similar services for the nation’s two other TRICARE regions, the South and the North.

[See also: Aetna’s healthy online gaming habit.]
 
The 21-state West Region includes nearly 2.9 million beneficiaries. The contract includes a transition period and five one-year option periods, beginning on April 1, 2013. The financial terms of the contract were not released.
 
Approximately 800 full-time employees will be dedicated to PGBA’s West Region contract. The employees will work at existing PGBA or BlueCross facilities, but the locations have not been finalized. Employees will work in claims processing, customer service, fiscal services and information systems.
 
PGBA has helped administer the military’s health care program for the past 30 years. It currently serves more than six million beneficiaries and processes more than 60 percent of the nation’s TRICARE medical claims as a subcontractor to Humana Military Healthcare Services in the South Region and to Health Net Federal Services in the North Region. With the addition of the West Region in 2013, PGBA will be responsible for processing TRICARE medical claims for the entire nation.
 
In 2011, PGBA processed approximately 40 million TRICARE claims from the North and South regions with an average completion time of five days or less while maintaining accuracy rates above 99 percent, according to company officials.

“The West Region award is a significant win for PGBA,” said Michael J. Skarupa, PGBA president and chief operating officer. “Our employees are committed to excellence, and that commitment has helped PGBA build a national reputation for its ability to provide state-of-the-art technology and cost-effective administrative services for healthcare.”

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Article source: http://www.healthcareitnews.com/news/bcbs-south-carolina-company-process-tricare-claims

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