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PAYER FAQ
PPO FAQ
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"We were never just an income stream to Ecom PPO Advisors, as it was clear their method was to make sure we were thrilled to pay them because they brought so much value. More than any other single attribute, Ecom does what they say they’ll do."
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Why is Ecom PPO Advisors better than our current plan?
At the forefront of the industry, only Ecom PPO Advisors navigates payers through hundreds of PPO networks to pinpoint their one-of-a-kind “best fit” primary PPO grouping. We estimate and promise unheard-of managed care savings tied to your company’s most effective PPO network selections for your organization’s particular needs. Once we’ve guided you to the best customized networks, we supply value-added network administration services at no additional charge.
How is it possible to minimize out-of-network claims?
At Ecom PPO Advisors, we’ve found yet another way to redefine the industry. Based on our proven, patent-pending technology, we’ve developed a method to substantially minimize out-of-network claims or “white space.” White space also will be reduced by less reliance on secondary networks, wrap networks or other out-of-network solutions. Our personalized Member-Level Primary PPO Selection analysis for each company scouts out where your individual members and their families have been seeking medical attention, and pinpoints the ideal individual PPO to fit. Your company’s savings increase even further – achieving a 95-97% in-network dollar penetration. Plus your members keep their preferred providers and at in-network costs.
Does Ecom PPO Advisors always use the same networks in the same geographic regions?
No – that's why we have developed relationships with such a wide array of networks across the nation. Until Ecom PPO Advisors analyzes the data, there is no way to predict which network is best for a particular client. A PPO that is perfect for one client in one area can be the third or fourth choice for another client in the same area. The data analysis is critical to accurately projecting the savings from a particular PPO.
Which networks does Ecom PPO Advisors work with?
Ecom PPO Advisors currently works with more than 120 top-tier national and regional networks, and we continually contact networks looking for the best deal for our clients. We are completely independent of the PPO networks so that we can objectively offer the best networks to our clients.
Who holds the contract with the PPOs?
In most cases Ecom PPO Advisors holds the contract with the networks with full disclosure to the client and the networks. The client may hold a direct contract with the networks, but through Ecom's collective buying power, we can typically secure a lower access fee for the client.
Does Ecom PPO Advisors reprice every claim in-house, or does it depend on the PPO to do some of the repricing?
Ecom PPO Advisors reprices through multiple established workflows, and often has several ways to reprice one specific PPO. Regardless of the workflow, Ecom returns all repricing information in a single source. Without fail, we disclose to the client the PPOs we’re recommending. The client has the final decision about which PPOs are utilized.
Can Ecom PPO Advisors deliver claims electronically?
Yes. In fact, we go beyond a simple electronic transmission. Ecom PPO Advisors offers a technology common denominator – we can deliver Electronic Data Interchange (EDI) claims already repriced to the client. And we also can take paper claims, turn them into electronic data, reprice the claims and deliver the end product via EDI to the client. Most of our clients receive 100% of their claims electronically.
What data format is required by Ecom PPO Advisors to deliver EDI claims to a client?
Ecom PPO Advisors has always been committed to taking data in any available form and delivering it in any manner required by the client. Basically, we conform to the needs of the client in every case and never ask clients to change to meet our needs.
Is the Internet data secured?
Ecom PPO Advisors uses the latest security technology to protect the data. Ecom employs a high-quality 128-bit encryption standard similar to the technology used by credit card companies and banks on the Internet.
Is Ecom PPO Advisors paid anything by the PPOs for their recommendation to the client?
No, we are not. We are often asked what a PPO can do to get more of our business, and the answer is always the same. We'll evaluate the data and other key items, and if the PPO is best based on our system analysis, then we will recommend the network to our client.
There are rumors of health plans that are promised 45 percent or more managed care savings. Is that true?
While there are managed care contracts with discounts exceeding 45 percent, the first question to ask is: “What figures are used to achieve the managed care savings?” Many health plans incorporate coinsurance, deductibles, PPO savings and other items into the managed care savings figure. With Ecom PPO Advisors, our numbers are based solely on the provider contracts, or PPO savings. Our figures do not include the additional plan savings of coinsurance, deductibles, and other items, and do not wrap in the “soft savings” or operational effects the value-added workflow provides. Simply put, you can add up the PPO savings, plus tack on the additional plan savings of coinsurance, deductibles and “soft savings” from value-added workflow – ultimately generating the maximum total savings possible. |
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As a PPO, why would my company want to work with Ecom PPO Advisors?
Ecom PPO Advisors is not a PPO, and essentially serves as an independent marketing organization for PPOs. We provide PPOs with performance report cards and feedback on their effectiveness. Our new Member-Level Primary PPO Selection service allows PPOs that are the “best in class” in a given market to prevail where typically the selected PPO covers the most people in a traditional geography-based analysis. Ecom is unbiased, and levels the sales playing field because all PPOs are treated equally based on their own merits. We also enforce the PPO requirements with payers.
Which networks does Ecom PPO Advisors work with?
Ecom PPO Advisors currently works with more than 120 top-tier national and regional networks, and we continually contact networks looking for the best deal for our clients. We are completely independent of the PPO networks so that we can objectively offer the best networks to our clients.
Who holds the contract with the PPOs?
In most cases Ecom PPO Advisors holds the contract with the networks with full disclosure to the client and the networks. The client may hold a direct contract with the networks, but through Ecom's collective buying power, we can typically secure a lower access fee for the client.
Does Ecom PPO Advisors reprice every claim in-house, or does it depend on the PPO to do some of the repricing?
Ecom PPO Advisors reprices through multiple established workflows, and often has several ways to reprice one specific PPO. Regardless of the workflow, Ecom returns all repricing information in a single source. Without fail, we disclose to the client the PPOs we’re recommending. The client has the final decision about which PPOs are utilized.
Is Ecom PPO Advisors paid anything by the PPOs for their recommendation to the client?
No, we are not. We are often asked what a PPO can do to get more of our business, and the answer is always the same. We'll evaluate the data and other key items, and if the PPO is best based on our system analysis, then we will recommend the network to our client. |
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