Pinnacle Claims Management

$109,432 a year. That’s how much one organization saved on a *single employee* when PinnacleRx Solutions took a closer look at the prescription details. And that’s just one employee. We do this for hundreds of employees, helping companies save millions. How? Simple: by rolling up our sleeves, digging into claims data, and uncovering the savings others miss. This is what sets PinnacleRx Solutions apart. The big PBMs don’t delve into the details. We do (and we love it). Because we know the details are where the true savings, and true value, lie. #HealthcareSavings #PharmacyBenefits #CostContainment #PinnaclePerspective

Pinnacle is growing fast. And we’re hiring people who want more than just a job. Here’s what to expect: — Meaningful impact — A team of people who care — Tracks to career growth Interested in working with us? 👉 Swipe through to see what makes Pinnacle different, and check out our open positions here: https://lnkd.in/esEwQP8V #NowHiring #Hiring #HealthcareJobs #FinanceJobs #PinnacleCareers

Want to save on healthcare costs? Here’s a rule of thumb we’ve noticed: The biggest wins often come from the least-flashy work. Medical bill review. Building a smart plan. Out-of-network negotiation. These might not be “shiny new objects,” but they drive real savings for our clients. In fact, Pinnacle clients see 68% average savings on out-of-network claims. And with claims under $5,000 (96% of them), Pinnacle takes on the responsibility directly. That’s how real cost containment happens: digging into the details, line by line. Maybe it’s not flashy to some. But smart savings and better healthcare will always be shiny to us. ✨ #HealthcareCosts #MedicalBillReview #SelfFunding #HealthInsurance #CostContainment

Thinking about self-funding but stressed out about the possibility of catastrophic claims? There’s good news: Smart self-funding doesn’t have to put your business at risk. Swipe through to see how stop-loss insurance protects your plan — and why self-funding doesn’t mean unlimited risk. 👇 #StopLossInsurance #SelfFunding #HealthBenefits #EmployerBenefits #HealthPlans

Consider this your annual check-up. How is open enrollment going? We know: it’s an incredibly busy time for HR and benefits leaders. The details feel overwhelming: — Changes in communication plans — Managing new employee questions — Balancing cost containment with employee satisfaction If your pulse is a little fast, let’s slow things down. It’s time for some check-in questions to help you handle this season. Answer them below and let us know how you’re doing in the comments. 👇 #OpenEnrollment #EmployeeBenefits #BenefitsLeadership #HealthcareCompliance #CostContainment

Great to connect with so many peers and partners at the Hospital Association of Southern California (HASC) Associate Members & Partners Event this week. Special thanks & recognition to Paul Young, Senior VP, Public Policy and Reimbursement at HASC, Keynote Speaker Shannon Sedgwick, Senior Director at Los Angeles County Economic Development Corporation (LAEDC), and Katrina Quinto, Director, Membership Services at HASC — so glad to be a part of this event! Always valuable to share ideas and learn from others who are working to move healthcare forward. #HASC #HealthcareSolutions hashtag#HospitalLeadership

Open enrollment season is here — are you ready? 🍂 In our latest edition of The Self-Funding Playbook, we’re breaking down what employers and brokers need to know this fall: ✔️ How to prepare with your TPA partner ✔️ Common enrollment mistakes to avoid ✔️ What the “Big Beautiful Bill” means for you Pinnacle is here to simplify the process and help you support employees every step of the way. 👉 Dive into our September newsletter for insights, strategies, and news you can use. #Pinnacle #OpenEnrollment #Healthcare #SelfFunding

We are proud to be in Monterey this week for California Association of Joint Powers Authorities (CAJPA) 2025! 🌊 Our team is here connecting with leaders in self-funded healthcare and joining conversations on how we can keep pushing the industry forward — especially when it comes to discussing pooling risk with school districts, municipalities, non-profits, and more. Shout out to Amanda Dal Cielo, Jason Watson, and James Kim for the great round of golf on Tuesday 🏌️ We at Pinnacle would love to hear how your organization is working through today’s challenges and opportunities. If you’re at the conference, we’d love to connect. 👋 #CAJPA2025 #SelfFundedHealthcare #HealthcareLeadership #EmployeeBenefits #HealthcareInnovation

🤔 Still weighing the pros and cons of moving from a fully-insured health plan to a self-funded one? For many employers, the biggest advantage is simple: control over your own destiny. Rather than paying fixed premiums regardless of the claims, self-funding lets you pay for the care your employees actually use. That translates into… — Savings — Flexibility — More visibility Maybe it’s not right for every organization. But for many, self-funding opens the door to smarter plan design—and more use from your employees. #SelfFunding #SelfFundedHealthInsurance #HealthInsurance

Do you know what a “gag clause” is? If not, it can potentially cost your health plan hundreds of thousands of dollars in penalties. Meet the Consolidated Appropriations Act of 2021. In this legislation, group health plans (like self-insured employer plans) are prohibited from agreeing to any contract language with the following limits: 📝 Accessing de-identified claims and encounter data electronically. 📝 Sharing that data with third parties for plan administration or quality improvement. 📝 Sharing provider cost or quality of care data with members, providers, or business associates. But that’s not all. Plans have to attest that they have no such clauses in their contracts. And they have to do so every year. If you miss the December 31st deadline for that attestation, penalties can reach… ⚠️ $100 per day, per participant. That’s why you need a few best practices (see below). Transparency in healthcare starts with compliance. But it’s not compliance alone. This is your reminder that you can turn regulatory requirements into strategic benefits. Lower your costs. Negotiate smarter. Empower employees to make better healthcare decisions. Do it right, and you’ll never have to worry about the gag clause. #HealthPlanCompliance #CAA21 #SelfFundedCare #EmployerBenefits #PinnacleDifference