FAQ
How does PAI ensure a smooth transition with new groups?
PAI has a comprehensive quality control procedure for new groups.
- It encompasses training the dedicated PAI service team, so that they are familiar with the group's unique benefit plan.
- Plan documents are thoroughly audited, so they can be in-hand no later than fifteen days after the effective date.
- The claims processing system is then tested to validate co-payments, maximums, visits, and benefits processing.
- PAI's Quality Control department audits 50% of all claims processed for the first two weeks of the plan. During weeks 3 and 4, we audit 25% of all claims. We continue with our 5% daily audits throughout the term of the plan.
What claims processing system does PAI use?
PAI has used QicLink since 1996 and QicClaim since 1985. In 2003, we are making significant capital investments in our system to meet HIPAA-EDI standards.
How does PAI monitor claims?
- 100% of all claims over $10,000 are reviewed thoroughly.
- 5% of all claims are audited on a daily basis.
How does PAI monitor service?
- Customer Service calls are monitored to ensure benefits are quoted correctly. Information regarding the call is entered into "CallTrax" so that we have record of all customer calls. In addition, unit supervisors monitor the number of calls, time spent on the phone, and abandon rates to ensure we have appropriate phone coverage during peak periods.
- PAI unit supervisors call the group leader periodically to perform "satisfaction checks" and gain timely qualitative feedback on performance.