FAQ
How does PAI ensure a smooth transition with new groups?
If your group is new to self-funding or switching from another administrator, you want to know that all the “moving parts” of your plan will be correctly set up and ready to go when the new plan year begins. PAI has comprehensive quality control built into to the new group implementation process. Consider the value we bring to the table:
- The dedicated customer service unit is fully briefed on your group's unique benefit plan. They are prepared to answer questions and explain how the benefits work, so your employees know what to expect from the plan.
- PAI offers full-service plan document support. We first draft a plan document for your review, based on your chosen plan of benefits. The plan document is ultimately the group’s responsibility, and groups must seek their own legal guidance. However, we will prepare a document based on our standards and customized for your plan of benefits. We offer helpful information related to healthcare reform requirements and other compliance issues. We will also coordinate with your stop loss carrier when exceptions are requested and issue amendments when you make plan changes. We will even manage booklet production, upon request.
- Implementation of your plan flows through a process of communication, documentation, and testing. Our Account Executives work to ensure that we capture the intent of your group with regards to how the benefit might be applied in the real world. The details of your plan are captured in our central database, which then becomes the source for the plan building team and customer service.
- After your plan’s benefits are built in the system, we begin the claim testing process. Once claims pass our testing requirements, we begin processing but continue monitoring. Audits are done on an on-going basis by our parent company. We also audit all claims over certain threshold amounts that have been established internally. This quality check is done on a daily basis by our internal quality control department.
What data security measures are place?
PAI has a comprehensive security policy in place to protect patient information and prevent unauthorized access. Policies and procedures encompass technology, physical security, and training and education. We meet or exceed standards set in the HIPAA Privacy and Security regulations, including HIPAA HITECH regulations.
What about ongoing service?
PAI’s customer support team uses a desktop system for tracking service calls and navigating to the information requested by the caller. The system allows us to record details about the call, aids in retrieval of member-specific information, and has scripting capabilities that allow for specific messages or information to be delivered consistently to a target group. With this system, PAI can tailor administration to the variety of needs and support inherent among our self-funded groups. In addition, we always have a record of the information and flow of service provided by our service representative.