Third Party Administrator Services (TPA)
Providing an integrated approach of network access, cost controls, and claims payment

Download the South Central Preferred TPA Services Brochure

Extensive Network

SOUTH CENTRAL Preferred (SCP) gives members more choices through access to one of the most comprehensive networks in south central Pennsylvania. As a result of nearly 95% of healthcare providers in Adams, Cumberland, Dauphin, Lebanon, Perry, and York counties participating in our network, we are able to pass along substantial savings through carefully negotiated fees. In addition, we participate with other regional networks and have a national network available for employees living and traveling in other states.

Clinical Expertise

Medical management services are provided by our employed team of registered nurses, a clinical pharmacist and a physician as our full-time Medical Director. Our nurses ensure timely and efficient delivery of care by evaluating both inpatient and outpatient services, reviewing policies, and using national and local standards to measure provider performance. The team analyzes and recommends proven, evidence-based strategies to control medical and pharmaceutical costs and improve patient outcomes.

Competitive Fees and Discounts

Employers benefit from the significant savings that are achieved by carefully negotiated fees from providers and healthcare facilities. Additional savings are also achieved by our low administrative fees. As a result, our rates compare very favorable to other carriers.

Comprehensive Administrative Services

As a third party benefits administrator, we provide a complete line of claims administrative services. Some of the many services we provide include:

  • dedicated and recognized member and client service representatives
  • high quality benefits interpretation and regulatory compliance support
  • medical, dental and vision claims processing and financial reconciliation
  • comprehensive monthly reporting to identify trends and financial performance of the medical and prescription plan
  • medical management
  • analysis of claims to determine case management candidates
  • pharmaceutical management
  • health insurance portability and accountability act (HIPAA) compliance
  • reinsurance coordination
  • COBRA administration
  • out of area network coordination

Self-insuring provides many benefits

As a self-insured employer, you assume the risk and pay for the medical benefits of your members rather than paying monthly premiums. Some of the benefits include:

  • Benefit plan flexibility - As an ERISA-eligible employer, you can design a benefit plan that meets the needs of your employees. You are not required to follow state mandated health and welfare benefits.
  • Cost based on usage - As a self funded company, you never pay more than your actual expenses. You fund the exact amount of the claims, resulting in improved cash flow for your company.
  • Lower administrative expenses - At most insurance companies, fees for administrative services consume 10- 15% of each premium dollar you pay. SOUTH CENTRAL Preferred’s low administrative fees result in significant savings. Also, as a selffunded company, you need not pay Pennsylvania insurance premium tax.
  • Paper-free convenience. All physicians, hospitals and ancillary providers in our network send their bills directly to us.
  • Reinsurance limits the employers liability

To Learn More

For more information about how SOUTH CENTRAL Preferred can help your business succeed, please contact us at (800) 842-1768.

Disclaimer    Privacy Policy    HIPAA Statement

All text material on this web site is the property of South Central Preferred.  Any reproduction or redistribution of this material is prohibited without the express written consent of South Central Preferred. Reproduction or redistribution of photographs or illustrations appearing on this web site is strictly prohibited.

Medical necessity review criteria used by the Medical Management department of WellSpan Population Health Services/South Central Preferred are available by calling the Medical Management department, 717-851-6801 or 800-888-1929. The criteria will be sent to you by mail, fax or e mail.