GOVERNMENT AGENTS

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About Us


PGBA, LLC provides fiscal intermediary and management information services to the Department of Defense (DoD) under TRICARE Managed Care Support (MCS) Program subcontracts. The Company’s major customers are prime contractors for DoD, Humana Military Healthcare Services, Inc.and Health Net Federal Services, Inc. In 2007, PGBA processed over 31 million claims and paid $5.3 billion in benefits on behalf of TRICARE beneficiaries. PGBA also furnishes administrative services for Medicare Advantage health plan products.

 

PGBA is a proven leader in technology integration for the Department of Defense (DoD). Our parent company, BlueCross BlueShield of South Carolina (BCBSSC), is the largest government healthcare contractor in the United States.

 

Furthermore, PGBA’s award-winning Web site, myTRICARE.com, is an established front runner in providing innovative self-service solutions for TRICARE customers. myTRICARE.com was first to market with fully secure functionality for users to access their TRICARE claims information and was the first to deliver a real-time interactive Internet-based claims submission system with XPressClaim™. Read more about our quality awards and certifications.


Our success in serving our government customers is a result of our commitment to continuously improving exceptional performance. We accomplish this through:

  • Constantly monitoring critical performance metrics
  • Proactively detecting and preventing problems
  • Recognizing and rewarding exceptional results
  • Enhancing operations through formal continuous improvement program
  • Developing our employees through ongoing training and job progression programs
  • Strictly adhering to contract requirements and ethical business practices

As leaders in technological innovation, PGBA has:

  • Designed and implemented new adjudication logic for the next generation of TRICARE contracts, improving processing speed and accuracy.
  • Expanded capabilities on the PGBA Web site, myTRICARE.com. The site gives TRICARE beneficiaries, providers and government agents easy access to information and secured claims related data.
  • Enhanced XPressClaim™, a Web-based process for online real time claim adjudication at the point of provider care to allow entry of institutional claims in a HIPAA-compliant UB-04 format. This no-cost EDI option is targeted at low volume providers.
  • Continued to deliver outstanding performance to our customers.

 

Claims Processed

31,072,695

Claims Cycle time (< 30 Days)

99.91%

Inquiries Processed

877,022

Inquiries Cycle time (< 15 Days)

99.95%

Telephone Calls Processed

2,573,339

 

More Information About Us

Find people on our organizational chart or check out our latest annual reports. 2008 Annual report; 2007 Annual Report.


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