Medical Stop Loss – Preliminary Claim Unit (PCU)
The Preliminary Claim Unit (PCU) is
responsible for receiving early notification
of potential
claims via 50% notices, large
case management reports and
pre-certification data. With early
notification of potentially high dollar
expenses, PCU works to identify which
expenses could be reduced. Any
reduction in costs will help preserve patient
lifetime maximums, while reducing costs for
the Plan and Carrier.
The PCU staff works with the
administrator to explore repricing options
in order to reduce Plan costs. PCU
assists with out-of-network claims, claims
with questionable charges, network claims
with minimal discounts and/or excess
charges, and charges for ongoing treatments,
such as dialysis, high cost infusions,
chemotherapy, radiation, etc.
PCU staff also contacts TPAs for
information such as current course of
treatment and claims paid/pended to date
information to establish potential liability
for both reserving needs and underwriting.
For more information about Preliminary
Claim Unit, please contact
Jennifer
Hill, PCU Manager.
Appointment Process
