By: Nic Hayes
Since its inception in 1981, Planned Administrators, Inc. (PAI) has been on a mission to make benefits better. Born out of the necessity for cost-effective third-party administration (TPA) of self-funded healthcare products, PAI has strategically positioned itself as a leading national TPA. Its core competencies include innovative administration, creative solutions, and cohesiveness of products, platforms and applications — with exemplary service.
Innovative Administration
PAI solves administrative challenges for all clients by offering tailored solutions through its expansive product portfolio of cohesive benefits solutions.
PAI’s products, services, and solutions include:
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Superior networks
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Self-funded health care plans, including preferred stop loss partners
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Limited benefit plans
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Specialty administration, including business process outsourcing
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Pre-certification
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Utilization review
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Case and disease management
- Health coaching + wellness programs
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Pharmacy benefit management
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Telemedicine
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COBRA
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HSA/FSA/HRA
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Data analytics + reporting
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Property & casualty + workers compensation
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Various vendor partnerships + point solutions
Creative Solutions
PAI focuses on innovative administration and diversification of services. The applicability and creativity of PAI’s solutions can be seen in the success they have achieved across different spaces.
Dental
PAI provides dental administration for a carrier in the Northwestern U.S. to ease the carrier’s administrative burdens, including administration for preferred provider organization (PPO) plans, health management organization (HMO) out-of-network claims, Medicare Advantage and Medicaid plans. The contract started with approximately 43,000 members; in partnership with PAI, the contract has grown to more than one million members and 975 plans.
Primary Care
In 2023, PAI and Proactive MD partnered to provide clients with broad-scope advanced direct primary care that extends beyond the clinic walls. Proactive MD’s integrated model, Proactive Total Care, includes partnering with companies to provide employer-sponsored onsite or near-site wellness centers to help companies control costs and deliver more efficient healthcare.
Cost Containment
PAI partnered with Health @ Scale to identify inappropriate healthcare claims before they are paid. Additionally, members are guided through the entire continuum of care and steered to the best specialists at the best value.
PAI Precision Care – a MSK solution provides member with best-in-class steerage and therapy through partners Bardavon and Nible Health.
Additional Benefits + Business Process Outsourcing
PAI created, branded, and will administer Minimum Essential Coverage (MEC) and MEC Plus products for BlueCross BlueShield of Kansas to offer groups for competitive purposes.
PAI’s administration is not limited to carrier administration. It also includes business process outsourcing; currently including prison system health care claims that incur outside of the organization and EAP claims for a large EAP and mental health organization — demonstrating the flexibility to its services.
Cohesiveness with Partners
Cohesive products, platforms, and applications allows for a seamless client experience. For example, PAI offers large self-funded Property & Casualty clients an integrated, comprehensive model for workers’ compensation administration that includes a physical therapy network and analytics. Our partnership with Fairos to offer reference based pricing (RBP 2.0) means less risk for members while keeping costs down for employers — without compromising quality.
Exemplary Service
As a trusted TPA with solutions to meet any need, PAI helps organizations control costs, deliver more efficient healthcare, and attract and retain top talent. “Every employer is looking for ways to control healthcare costs without sacrificing quality care for their employees and families. Self-funding gives the opportunity to save and provide flexible options. PAI goes beyond that and provides white-glove customer service with tailored solutions,” added George Stiles, President and COO.
While PAI makes benefits better, their mission goes beyond that. They are truly helping your organization run better and keep your employees satisfied through lessening the burden of benefits administration.
We are proud to feature Planned Administrators, Inc. on the Granite List.
