How Planned Administrator’s Inc. is Changing the TPA Landscape

Navigating the intricacies of our health care system can often feel like trying to solve a complex puzzle. That's why our mission is to simplify the process for our valued clients and members. We are dedicated to providing clarity and guidance in an otherwise confusing landscape, ensuring that you can access the care you need with ease and confidence.

By collaborating closely with our clients and their trusted brokers/consultants, we tailor a comprehensive program that is specifically designed to address the diverse and individualized requirements of their workforce.

Our programs are centered around providing personalized, in-person care led by physicians. This approach ensures that our members receive direct, hands-on attention and comprehensive medical guidance. Additionally, we offer virtual options as supplementary resources, allowing flexibility for consultations, follow-ups, and accessing medical advice remotely. This combination of in-person and virtual care options aims to cater to diverse patient needs, ensuring convenience and continuity in healthcare needs.

Our goal is to deliver personalized and exceptional care to all our members. We’ve recently embraced augmented intelligence (AI) technology to personalize member navigation by incorporating member claims data into our cost/quality calculators. By analyzing member data, we can pinpoint the best healthcare providers to address each member’s specific needs. Leveraging this data-driven approach, we identify top-quality care within specific regional areas. For example, we can locate the best cardiologist for a 47-year old male member who is overweight and diabetic; not just the one with good generalized outcomes.

While other TPA’s shy away from using AI to help with member navigation, PAI sees this cutting-edge technology as a valuable tool to deliver tailored results, ensuring the most cost effective results for both our clients and members.

We are also leveraging AI technology to assist with claim reviews to detect inappropriate/wasteful billing. Instead of relying on manual, time-consuming, post-payment reviews of claims, we are able to verify appropriateness of care on a pre-payment basis by comparing the provider specialty, diagnosis, and procedure code to millions of claims from similar provider specialists. If everything aligns, the claim goes to payment; if not, we flag it and request medical records to see if the care is appropriate. The AI technology is not a replacement for human decision-making, but it is an important supporting tool.

In addition to administering health plans to self-funded employers, PAI offers a full portfolio of administrative services to carriers and service providers, allowing them to focus on what they do best. This allows us to prioritize delivering affordable care for everyone. Our suite of products include dental, vision, term life to include an AD&D option, short-term disability, accident, MEC and MEC+ plans, as well as affordable health care options for part-time and hourly employees.

Our goal is to deliver personalized and exceptional care to all our members.

Our vendor partners have been meticulously selected based on their expertise, reliability, and commitment to top-notch security standards. Each partner must undergo a rigorous security assessment to ensure that our clients' data and systems are always protected. While we are capable of integrating with any solution our client’s desire, choosing to work with our preferred partners guarantees access to the most advanced and cutting-edge solutions in the industry. With our preferred partners, our clients can confidently rely on best-in-class technology to meet their business needs.

At PAI, we strive to offer tailored products and services to our valued clients and members. We understand that navigating healthcare systems can often feel overwhelming and complex. Our mission is to simplify this experience for you. Our aim is to deliver top-notch solutions that enhance your benefits and make them even better.