Business Process Outsourcing

Planned Administrators, Inc. has been a subsidiary of South Carolina’s largest health insurance carrier since 1984. This ownership gives us the stability, support and knowledge of large carrier operations. Using this power, Our carrier administration strategy is to become an extension of them. We collaborate with our partners to develop a full suite of administrative services, from claims processing, customer service centers, enrollment support, member communication design, and ID card production and fulfillment.

PAI has collaborated with various carriers to administer a number of voluntary products since 2004 covering more than 200,000 members. Recently, PAI was selected by one of the largest national carriers in the northwest to administer their dental plans. This multiyear contract includes more than 25,000 subscribers and proves PAIs flexibility and agility to meet any customer needs. In addition to this contract, PAI’s carrier administration portfolio continues to grow as our ability to white label our business products and procedures expand.

Benefits of PAI

My Benefits Manager^SM

Our secure portal, My Benefits Manager, links carriers and members to all the tools they need to manage benefits. It is a single secure source for information about specific benefit plans.
My Benefits Manager benefit portal links members to all the tools they need to manage their benefits. It is a single secure source for information about members’ specific benefit plans.

Members can securely log into their account through www.paisc.com or download the “My PAI” mobile app to:

• Find a network provider
• View plan document and benefit summaries
• Access claims and explanation of benefits
• Print, view, share or request an ID card
• Access pharmacy benefits
• Access forms
• View member discounts and value-add programs
• Email Customer Service

Programs and initiatives to support and enhance our customer service:

• Core team of customer service advocates with primary goal of supporting the enrollees
• Combined provider and member calls to ensure experience is equal to all parties
• Language Line Assistance — over 144 languages for translation
• 100% of calls are recorded and logged

Customized Reporting and Communication
We work with our carrier partners to meet their reporting and communication requirements.

Reporting

• Full claims file
• Standard QicLink reports
• Customized reports

Communication

• Plan enrollment materials and ID cards
• Member EOBs customized by plan sponsor
• Standard or carrier-specific claim forms

Compliance Support
PAI provides assistance to help you stay in compliance with Affordable Care Act (ACA) regulations and keep you posted on changes that may affect your group or plan. In addition to providing the reporting you need for PCORI, we also provide assistance with your SBCs and plan document writing.