Preferred Provider Contracting
Preferred Provider Organization
Network-Savings. Most of today’s health benefit plan designs are built around Preferred Provider Organizations (PPOs), encouraging the use of in-network providers by offering lower deductibles and coinsurance. PPO plans allow members to choose providers while giving the employer substantial cost savings.
Our Network in the Carolinas
Competitive, Efficient, Expansive. Primary PhysicianCare’s PPO network includes more than 8,000 physicians, facilities and hospitals throughout the Carolinas. Here are some highlights of our PPO network:
- Our highly-competitive contracts allow us to provide our self-insured clients with cost savings that are similar to those of large insurance payers.
- Our fast claims payment turnaround through auto-adjudication and EDI makes us a respected payer in our market.
- The low turnover and inherent stability of the Primary PhysicianCare PPO network enables members and their families to build stronger, more lasting relationships with their physicians.
- The continuous expansion of our proprietary network of hospitals and physicians allows us to offer greater choices to all plan members.
- Our network includes the region's finest research facilities for transplants and other services.
Direct Contracting
Strength in Numbers. A key employer in a smaller community can have great negotiating power with healthcare providers in that area. Similarly, a group of employers can negotiate collectively with the providers in their area to achieve highly favorable pricing for their plan members. Primary PhysicianCare assists employers in direct contracting with providers using our network management staff and executive support. We arrange meetings with key providers, negotiate fees, provide legal contracts for all parties, and can build the fee schedules directly into our system for auto-adjudication.
Our Networking Strategy
Cost-saving Hierarchy. We provide our clients with access to a wide range of Preferred Provider Organizations (PPOs)—from the best local and regional networks to large national PPOs—in order to meet the needs of their employees. Our claims system allows us to establish a hierarchy of PPO networks, applying the lowest fee network to a given claim when networks overlap. For a large client with many locations nationally, we establish the following network strategy:
- Direct contracts with local providers (optional)
- Best county PHO if available
- Best local/regional PPOs
- Best national PPO option
