Multi-Channel Claims Access on a Unified Digital Platform

PGBA helps you empower your customers with multi-channel, online access to claims information.

We provide web tools and customer-facing portals that seamlessly integrate with our partners’ policy and claims administration systems — letting members view and manage their claims, coverage and eligibility details in real time. We can develop stand-alone web tools or integrate them with the tools you have in place today. Meanwhile, our online patient directory allows providers to enter patient data into their own directories, which then populates submitted claims.

With PGBA’s multi-channel model, registered users can access health plan information and support via their preferred means — whether it’s by phone, live chat, email or self-service. On one convenient, secure digital platform, users can…

• Submit claims with real-time adjudication
• Review policy details
• Check claims status and eligibility
• View EOBs and remittances
• Receive and perform online authorizations and referrals
• Contact customer support

In addition, the myTRICARE® Web portal provides administration and management of health care claims including health care claim processing and reimbursement. TRICARE customers can access online real-time health care claims information to: 

• Check Preventive Care Eligibility
• Create Reports — Claims Data Reports, Active Duty Service Member Reports, Benefits Summary Reports
• Pay Enrollment Fees
• Research Recoupment Requests
• Sign up for Electronic Remittance Advices (ERAs)
• Submit, Store, and Retrieve Claims Documents Electronically
• View and Update Other Health Insurance (OHI)

PGBA's most popular Provider feature is XPressClaim® — fast, free Web-based healthcare claims submission of CMS 1500 and UB-04 claims with instant results.