Medicare D Delivery System Claims Adjudication Retiree Benefit Outsourcing Short Term Disability COBRA Flexible Spending Accounts Health Reimbursement Accounts (HRA) Health Savings Accounts (HSA) High Deductible Plans Consumer Directed Plans	Case Management National Vendor Access Custom Plan Designs Cost Analysis & Plan Recommendations Provider Verification Wellness Programs Online Capabilities Reinsurance

Claims Adjudication

Professional Benefits Services is capable of providing full administration of self-funded medical, prescription, dental, vision and flexible spending accounts from enrollment to receipt and payment of claims. Our skilled claims analysts are highly trained and experienced in coding, analyzing and payment of claims, accepted electronically and by mail. Sophisticated internet technology allows employers to view claims on line, check payment status, and review deductible and out-of-pocket maximum balances.

Claims are professionally adjudicated according to nationally recognized standards and practices. Payments are produced through use of up-to-the minute technology within a guaranteed processing time of seven to ten days. PBS Analysts are available by phone each weekday from 8:00 a.m. to 5:00 p.m. EST to answer claim questions, check claim payment status and verify benefit eligibility. We pay careful attention to applying plan design when adjudicating your claims to assure preservation of the plan’s intent, non-discrimination, ERISA requirements, and the most cost effective application of your plan dollars. PBS performs continual audits to measure adherence to it’s quality metrics for payment accuracy, timeliness and plan application.