This is getting interesting as the entire Tri-Care situation has drug on forever and we don’t know if the lawsuit United filed against DOD had any influence on this recent award. There’s some history from a couple days ago at the link below.
United Healthcare Secures Tri-Care Military Defense Contract for Western USA Presently Handled by Blue Cross Contractor TriWest
Palmetto (PGBA) has been around in the west for quite a while as the contractor as I have sent claims through them when doing medical billing. I found this one page at Palmetto kind of interesting as it has all the billing and EDI information and questions, except right in the middle they will tell you how to tweet on Twitter:) I have never seen a compilation like this before.
TriWest is owned by 11 Blue Cross and Blue Shield plans and two University Hospital systems so this gets even more interesting and do they use software that was created by United’s Optum division? They could as it’s been around for a long time so integration would be easier. So through subsidiaries and ownership Blue Cross/Blue Shield has been all over the Tri-Care processing portion of the business for a long time. Ok so what’s next? We can speculate maybe and wonder if Untied will be offering Blue Cross some money for the Palmetto subsidiary some day? I say that as they kind of come in and buy all types of technology companies and if they are integrating with their own systems…well..hmmmm…
Back in 2009 the Tri-Care contracts all began and United was originally awarded the north from HealthNet, they protested and got it back. Right after this, Health Net sold its Northeast insurance and HMO units in Connecticut, New York and New Jersey to UnitedHealthcare. BD
FLORENCE, SC – PGBA, a BlueCross BlueShield of South Carolina subsidiary company has been awarded a new contract by UnitedHealth Military and Veterans Services (UMVS) to help process TRICARE claims.
TRICARE is the U.S. military's health care program for active-duty and retired service members and their families.
PGBA, based in Florence, S.C., announced March 16, it would 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.