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Network Management

Complete Preferred Provider Organization Management

During Calendar year 2007 we saved our clients more than $324 Million through PPO discounts by ensuring that they partner with networks that feature strong access, contract savings and management of provider practices. We are one of the few independent Network Managers who aggressively negotiate PPO contracts to ensure the quality of provider discounts. We work to eliminate the risk of “provider discount abuse” so our clients do not have to forfeit discounts obtained due to Silent PPO and PPO Stacking

We are a truly independent resource in evaluating PPO options, and have dedicated staff to network evaluation and management. One of the hallmarks of our independence is our guarantee that we will not provide inflated and misleading expectations of discounts.

Our focus on obtaining discounts includes four initiatives:


	Our PPO Complete process is used to select "best in breed" local, regional, and national networks for clients, as well as "wrap" networks that maximize the use of contracted providers. This includes over 110 different PPO contracts nationally. Selection criteria includes: access, disruption, reported savings and the overall quality of a network's contracts.

	We are one of the few TPAs nationally that has met the strict quality criteria to provide our clients access to networks owned by insurance companies like Nationwide Health Plans, Great West Life, Humana and Wellpoint (California).

	We have built several proprietary networks for our clients through direct negotiation with providers. In each case those networks have been constructed based on a thorough understanding of the local healthcare environment and "best practice" in contracting. This includes placing providers at risk for delivering efficient care through case rates and per diem reimbursements.

	EDGE is a discount negotiation product that provides important cost savings to employees who live outside the network service area, must seek emergency care while traveling, or choose to use non-network providers. If employees use providers who are not part of the primary PPO network, EDGE may allow them to avoid paying billed charges; these discounts may range from 5% to 40%. The EDGE product effectively reduces the cost of your employee benefit program.

Across our book-of-business 93.7% of services were received from contracted providers.

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