PGBA of Florence will soon help administer the United States Department of Defense's TRICARE health care program around the country.
The company was awarded the new contract by United Health Military and Veterans Services (UMVS).
UMVS was awarded a TRICARE contract to provide medical and referral management, care provider networks, customer service and claims processing, as well as management support including cost trend risk management, fraud and abuse detection, and quality management services in the West Region of the United States.
PGBA already performs similar services for the nations two other TRICARE regions, the South and North.
Around 800 full time employees will be dedicated to PGBA's West region contract. The employees will work at existing PGBA or BlueCross facilities, but the locations have not been finalized. Employees will work in claims processing, customer service, fiscal services and information systems.
PGBA employs approximately 2,000 people and has offices in Columbia, Florence, Camden and Surfside Beach, S.C.
Here's the full release from the company:
New Military Health Care Contract Means PGBA Will Expand Services Nationwide
FLORENCE, S.C. - A BlueCross BlueShield of South Carolina subsidiary company soon will help administer the U.S. Department of Defense's TRICARE health care program nationwide after being awarded a new contract by UnitedHealth Military & Veterans Services (UMVS).
PGBA, LLC, based in Florence, S.C., announced today that it will process TRICARE claims and provide claims-related customer service and sophisticated systems platforms, integrated with UnitedHealth Group systems, on behalf of beneficiaries, physicians and hospitals as a subcontractor to UMVS. UMVS, a UnitedHealth Group company based in Minneapolis, was awarded the TRICARE Managed Care Support contract to provide medical and referral management, care provider networks, customer service and claims processing, as well as management support including cost trend risk management, fraud and abuse detection, and quality management services in the West Region of the United States.
PGBA already performs similar services for the nation's two other TRICARE regions, the South and the North.
The 21-state West Region includes nearly 2.9 million beneficiaries. The contract includes a transition period and five one-year option periods, beginning on April 1, 2013. TRICARE is the U.S. military's health care program for active-duty and retired service members and their families.
Approximately 800 full-time employees will be dedicated to PGBA's West Region contract. The employees will work at existing PGBA or BlueCross facilities, but the locations have not been finalized. Employees will work in claims processing, customer service, fiscal services and information systems.
PGBA has helped administer the military's health care program for the past 30 years. It currently serves more than 6 million beneficiaries and processes more than 60 percent of the nation's TRICARE medical claims as a subcontractor to Humana Military Healthcare Services in the South Region and to Health Net Federal Services in the North Region. With the addition of the West Region in 2013, PGBA will be responsible for processing TRICARE medical claims for the entire nation.
In 2011, PGBA processed approximately 40 million TRICARE claims from the North and South regions with an average completion time of five days or less while maintaining accuracy rates above 99 percent.
"The West Region award is a significant win for PGBA," said Michael J. Skarupa, PGBA president and chief operating officer. "Our employees are committed to excellence, and that commitment has helped PGBA build a national reputation for its ability to provide state-of-the-art technology and cost-effective administrative services for health care. We look forward to expanding over the next year and working with UMVS to serve the TRICARE program and the members of our military in the West Region."
Headquartered in Florence, S.C., PGBA, LLC's principal business is processing medical claims and providing customer service for the U.S. Department of Defense's TRICARE program. PGBA employs approximately 2,000 people and has offices in Columbia, Florence, Camden and Surfside Beach, S.C. In addition to TRICARE, PGBA processes claims for other government programs and private insurers.
MBACC President and CEO and Grand Strand lawmaker offered the following comments regarding Blue Cross Blue Shield of South Carolina subsidiary PGBA LLC's renewed federal government contract:
"We are very pleased to hear that the multi-million dollar contract for the government-backed military health insurance program, Tricare, has been renewed to Blue Cross Blue Shield of South Carolina subsidiary PGBA LLC, protecting jobs throughout the Grand Strand and Pee Dee regions, " said Brad Dean, President and CEO of the Myrtle Beach Area Chamber of Commerce/CVB.
"Blue Cross Blue Shield of South Carolina is and always has been a silent economic giant in the Myrtle Beach area. Not only is it one of our communities largest employers, but it provides very stable and year-round jobs to its employees. This announcement signals an exciting future for Blue Cross Blue Shield and potentially more jobs for our region," said Dean.
Representative Nelson Hardwick, R-Surfside also adds, "The type and quality of jobs protected in Surfside Beach and Florence with the new contract will have a very positive impact on our local economy. I'm proud of the excellent work that began under Ed Sellers' vision and continues today under David Pankau's leadership. This is extremely good news for their organization, as well as the Grand Strand, Pee Dee region and palmetto state as a whole."