Founded in 1989 by nurses who believed every employer and employee deserves access to high-quality health benefits, we built a company with two distinct strengths. First, we have the programs, insights and expertise to bend the trend of rising healthcare costs. And second, we have a staff of incredibly dedicated, informed and responsive people who care about the members they serve. Our unique clinical approach has been a hallmark from the start. We’ve built a staff of experienced nurses and other medical professionals who apply their expertise to both the claims administration and health benefits management process. This integrated approach allows us to identify ways to save on costs for self-funded employers, without compromising the quality of care for employees and their families. It also makes our services more comprehensive and more effective than that of other TPAs. We also wanted to create a positive experience for everyone who works with us by being the most attentive and responsive company we could be. Our phones are answered by real people, not computers, making it easy for anyone to get the help they need right away. It’s a basic, but invaluable way of doing business. We’re also quick to respond to those who contact us by email, fax or through our My Prairie online portal. The expertise of our medical professionals is at the core of our claims administration, health management and wellness programs. This unique clinical approach ensures you get remarkable cost control with compassionate and personalized service. Our administration services extend far beyond claims. Whether you’re trying to keep up with current legislation, implement cost reduction solutions or have compliance questions, we’re here with answers.
We are an industry leader in benefits administration because unlike most TPAs, we have both experienced examiners and nurses working together under one roof. Our unique, coordinated approach saves our customers an average of 59% off submitted claims charges. We have had multiple customers experience a 0% increase in claims costs, year over year, due to our combination of solid claims management and innovative wellness programs. At Prairie States nurses audit every claim over $5,000 to ensure that inappropriate, duplicate and fraudulent bills are not paid. We also use a software module to confirm and verify the results of these efforts. Legitimate, clean claims are paid on your behalf. Claims administration also comes fully integrated with our wellness programs. This allows us to identify plan members who could benefit from care earlier rather than later. That in turn results in a better health outcome for the member and significant cost savings all around. Direct customer service is part of our claims administration, too. When a plan member has a question, they can speak one-on-one with the person who handled the claim from the start.