Benefits Administration
 

Health Plan Administration

Self-funded Plan AdministrationPrimary PhysicianCare provides fully-integrated medical plan administration.  Utilizing the most advanced technologies and expertise available in the industry, we assure total accountability and optimal performance.  Our EDI transactions, auto-adjudication, online portals, and electronic claims routing systems maximize efficiency and quicken turnaround time.  The goal at Primary PhysicianCare is to manage health plan costs while ensuring exemplary healthcare for your employees.
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Dental Plan Administration

Cost Control.  Using our fully-integrated approach, we provide complete dental plan administration services. Our nationally-aligned UCR fee schedule controls costs for the employer without sacrificing fee integrity for the provider.  Primary PhysicianCare has the power to manage dental plan benefits at all levels, including local employer-sponsored dental networks in specific markets.  Read More...


Flexible Spending Accounts

Convenience and Efficiency.  Primary PhysicianCare, Inc. has the ability to automatically generate Flex/HSA claims using Claims Link.  For debit-card-based Flex plans, Primary PhysicianCare has partnered with Metavante, the nation's leader in consumer-directed healthcare card systems.  The result is a convenient and efficient debit card, which can be used for the purchase and payment of qualified medical expenses.
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HRA & HSA Accounts

Real-time Availability.  Plan members are able to access funds and make healthcare purchases electronically from Flexible Spending Accounts, Health Reimbursement Arrangements, Health Savings Accounts, Transit/Parking Accounts and Dependent Care Accounts—all with one Master Card® or Visa® card.  Integrated banking partners provide real-time balances at the time of the card transaction.  Read More...


COBRA Administration

Hassle-free Compliance.  As part of our fully-integrated approach, Primary PhysicianCare offers complete COBRA administrative services.  We ensure compliance with COBRA regulations by providing required notifications, member election packets, premium collections, HIPAA Certificates of Creditable Coverage, and compliance monitoring.  All of our COBRA services are supplemented by ERISA attorney-certified COBRA plan document language.  Read More...


Compliance Services

Compliance is assured.  We offer a range of compliance services and publications to help our clients navigate the maze of federal, state and local laws and regulations related to benefit plans. Our services include: reviewing plan documents, policies and administrative processes to ensure that the plan is in compliance with HIPAA and annual notices to participants, including:
Notice of Privacy Practices, Women's Health and Cancer Rights Act Annual Notice, Notice of Creditable Coverage for Medicare Part D.  Read More...


Information Systems

Software Innovation.  Primary PhysicianCare has developed and patented a number of innovative software programs, making it possible for plan participants to access their medical records online.  We also provide several advanced reporting packages to enable employers to better understand the health of their employees.  These invaluable tools are offered in addition to electronic newsletters and wellness tips designed to empower members to make informed choices about their health.

Additionally, Primary PhysicianCare has partnered with DST Health Solutions, Inc. to provide core claims processing systems and data center support services for our claims administration operations.  DST Health Solutions' services support 340 healthcare clients—representing 30 million covered lives, 230 million health plan claims and 30 million physician business transactions annually.  For more information about DST Health Solutions, visit:  www.dsthealthsolutions.com.

 

Case Rate Negotiation

Pre-service negotiation of pricing, before the encounter. Re-directing care to more
cost-effective providers.

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Prevention Management

Health Advocates support plan members by
educating them on the importance of early
detection, prevention and primary care
bonding.

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