NHSI PPO MANAGEMENT SOLUTION
The PPO management and repricing system is a fully integrated enterprise
system that provides a PPO network, Payor or Health Plan a turnkey approach to
the management of its business. Modules include customer data management and
reporting, member eligibility, provider demographics and fee schedule
management, claim repricing, and billing and collections. The system is edi
capable and HIPAA compliant. The system can handle unlimited fee schedule and
rate components.
Our Strategy: The Single Source Solution
Unlike conventional methods of piecing together fragmented access to healthcare
management systems, our strategy employs a centralized and fully coordinated
management approach to the various systems necessary for the success of your
business.
NHSI’ Single Source Solution assumes the burden from PPOs that are otherwise
bombarded with network management efforts. This solution allows a regional PPO
to maintain its identity and strength while gaining access to systems, knowledge
base, and a national program for future business growth.
NHSI FirstSmart® PPO management System
The NHSI FirstSmart® System is a "turnkey" ASP module driven system that can
manage all aspects of a PPO networks’ business. This includes; development of
business rules, customer set-up, receivable management, provider demographics,
fee schedule management, and claim repricing. The system provides the
infrastructure necessary to manage multiple fee schedules and unlimited customer
and claim data. FirstSmart® will allow a PPO to focus on growth, and do what
they do best - manage a great network of providers.
Claim Management
NHSI will manage the claim "front end" process. This includes claim and document
scanning, OCR, repricing and data export to PPO customers. NHSI will provide
online access to images via a private labeled web site. This dynamic technology
will organize claim flow, reduce cost, and provide data control to the PPO.
Duplicate claims are reduced and claim TAT is improved.
Online Repricing
The NHSI Online Repricing application allows customers to reprice claims
remotely on a 24/7 basis. This application reduces repricing time, eliminates
faxed claims and provides immediate status of all repriced claims. The system is
equipped with a customer service module that can manage member calls and claims
questions. Internal tracking software allows management the ability to assess
all the adequacy of the customer service function.
Geocoding and Provider Accessibility Analysis
NHSI has developed proprietary software that assists in the implementation of
comprehensive PPO programs. Our analyses of data allow a PPO to fully understand
a group’s needs and apply provider access/disruption resolution strategies. NHSI
assists our PPO customers in matching demographic and actual claims data in
order to identify its customers’ needs, and design an individualized solution.
NHSI Patient Centered National Healthcare Network®
NHSI Patient Centered National Healthcare Network is comprised of more than
500,000 physicians and over 5,000 JCAHO accredited, acute care hospitals with
participating providers in all 50 states. Our network offers superior
metropolitan access augmented by extensive rural area coverage throughout the
United States. With more than 165,000 primary care physicians and 300,000
specialists, NHSI’ Preferred Provider Organization (PPO) truly allows health
plan participants and their dependents the freedom to select "preferred" care.
Our mission is to compliment your PPO with access to a national primary and
secondary "wrap" network. This powerful national -regional combination will
provide national growth and sustain the strength of the regional network
identity.