A Performance Legacy in the Public Sector

Since 1981, PGBA has specialized in serving the administrative needs of government health plans. Our portfolio features state and federal contracts — including claims and customer support for military, veterans’ programs, Medicare, Medicaid and correctional care.

For decades, agencies and contractors have turned to PGBA for our deep institutional knowledge. We understand government priorities, service member needs, and the nuances between public and private programs — making us a highly valued partner.

Past and present work includes:

• TRICARE: Health Net Federal Services, Humana Government Business, UnitedHealthcare Military & Veterans (TRICARE contract) — Contractor or subcontractor for the TRICARE military health plan since 1981. Claims processing for 50 million+ claims, and response to 3.1 million+ calls and 1 million other contacts annually.
• Correctional Care: Federal Bureau of Prisons (FBOP), North Carolina Department of Public Safety (NCDPS) — Claims processing and support services for inmate healthcare. Adjudication expertise to help customers manage the administrative process of healthcare claims and control inmate medical care costs.
• Veterans Health Administration, Health Net Federal Services, OptumServe and TriWest Healthcare Alliance:  Veterans Choice, Project HERO, Veteran's Administration Community Care Network — Subcontractor on these important veteran's health contracts supporting  the U.S. Department of Veterans Affairs Administration providing claims processing, customer service, provider data management and fiscal administration. 
• Medicare Advantage — Claims processing and customer service contact center services for large Medicare Advantage plans.
• South Carolina Department of Health and Environmental Control (DHEC) and South Carolina Center for Medicaid — Comprehensive customer service support via a Central Appointing System and the CareLine program. Call center services including management of inbound/outbound calls, voicemail, text communications, and live chat. The central point of contact for making appointments at health departments and clinic sites at the state level.

What Can We Do for You?
As a prime or subcontractor, PGBA can extend our services both within and beyond healthcare. Our business capabilities can easily transfer to a range of contexts — including state-level Medicaid, disaster response, benefits and program enrollment, non-medical insurance plans, and others. Contact us to learn more.