A Florence-based firm will now handle all of the administrative services for Tricare insurance claims for the nation.
PGBA, a BlueCross BlueShield of South Carolina subsidiary company, has been awarded the new contract by UnitedHealth Military & Veterans Services. Tricare is the U.S. military’s health care program for active-duty and retired service members and their families.
The contract was for the West region of the United States. PGBA is presently administering the other two regions of the country, in a series of one-year contracts, said BlueCross BlueShield of South Carolina spokesman Billy Quarles.
“This is a significant win because PGBA will now provide services to the Tricare program, healthcare providers and beneficiaries across the nation,” he said. “Our employees have provided outstanding and cost-effective administrative services in the North and South regions for years, and we are looking forward to working with (UnitedHealth) in the West region.”
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.
The UnitedHealth Group company, based in Minneapolis, was awarded the Tricare Managed Care Support contract and subcontracted with PGBA for administrative services, such as claims processing and medical and referral management, in the West Region of the United States, according to a release.
Approximately 800 full-time employees in South Carolina will be dedicated to PGBA’s West Region contract. Quarles said it was too soon to tell if additional employees would be needed to handle the contract.
The employees will work at existing PGBA or BlueCross facilities, but the locations have not been finalized, he said. 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.
PGBA employs approximately 2,000 people and has offices in Columbia, Florence, Camden and Surfside Beach. In addition to Tricare, PGBA processes claims for other government programs and private insurers.