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THE PPO NETWORK CENTRIFUGE

INETICO has revolutionized the way payors access PPO Networks allowing them to maximize In-network provider utilization by their members and escalate savings through PPO network partners whose focus is to establish viable per diem and case rate contracts . INETICO provides transparent claims repricing support on-line through INETIPASS, our web-based repricing system.

INETICO delivers unprecedented savings to you by identifying the most appropriate primary networks for your groups and members. Our detailed Geographic and Claims analysis program specifically pinpoints which network is most appropriate for your group. This detailed analysis can even identify specific members that may require alternate primary network access providing you with the highest possible savings. Since INETICO is an independent PPO relationship manager, we present the greatest savings opportunity to you through our national, regional or local PPO network partners. Often a wrap network with similar discounts to the primary network may be recommended as a logo’ed partner on the ID card to cover the gap for members who travel or who may be required to seek services unavailable through the primary network.

NEGOTIATION AND PRE-NOTIFICATION

INETICO's results speak for themselves with Out-of-Network claim savings averaging 15% to 26%!

INETICO’s team of expert analysts improve claims savings by negotiating with Medicare fee comparisons, U&C measurements and historical provider experience. The INETICO analysts provide discount security by requiring 100% provider sign-off.

INETICO NEGOTIATION DIFFERENTIATING ATTRIBUTES

  • 100% provider agreement sign-off
  • No patient balance-billing except for responsibility
  • All negotiators focus on provider relationship development to prevent member treatment disruption
  • Negotiation experience in every state in the U.S., as well as internationally
  • All billed charges negotiated from $1 and up

NEGOTIATION FEATURES

  • 3 to 5 day average turn-around
  • Automated settings to measure client’s UCR minimums and to kick-out claim negotiations that do not meet thresholds
  • All claims' status viewable live and available 24/7 on our web-based system called INETIPASS
  • Secure paperless web-based audit trail of activities, results and claims status

NEGOTIATION BENEFITS

  • Average client savings range from 15% to 26%
  • Any and all disputes are addressed and tracked to resolution, typically within 48 to 72 hours, on-line in INETIPASS
  • INETICO Pre-Notification proactively identifies claims prior to service and typically negotiates contract level discounts on non-par claims

PRE-NOTIFICATION DIFFERENTIATING ATTRIBUTES

  • Daily review of pre-cert reports to determine out-of-network activity
  • Case Rates, Fee Schedules and Per Diem agreements always attempted first
  • Pre-Notes addressed within 24 hours

WRAPS & SUPPLEMENTARY NETWORKS

Double-digit increases in healthcare expenditures are presenting greater challenges and pressures on payors to reduce their plan’s overall claims cost. INETICO has innovated two unique approaches to maximize claims savings that fall out of the traditional PPO network — Wrap Network Stabilization and Supplemental Clearinghouse programs

WRAP NETWORK STABILIZATION

INETICO’s Wrap Network Stabilization program captures the majority of non-par claims and features expanded provider access beyond the primary network allowing discounts similar to primary network agreements. If you are not using the PPO Network Centrifuge (INETICO’s solution to primary network gap management), your plan will benefit from Wrap Network Stabilization. INETICO has partnered with many of the strongest national and regional PPO networks to provide payors with the highest level of access and discounts for claims outside of the primary network. These networks require logo identification on the member’s ID card which provides clearly identified access to the payor, patient and provider.

SUPPLEMENTAL CLEARINGHOUSE

INETICO’s Supplemental Clearinghouse minimizes non-par claims loss with increased discounts that typically exceed U&C pricing. Utilizing these programs can result in the difference between expanded savings or  continued healthcare plan increases.  While the Supplemental Clearinghouse program does require EOB identification when payment is made, it does not require identification at the point of service nor
financial steerage.

WHY WRAP STABILIZATION AND/OR SUPPLEMENTAL CLEARINGHOUSE?

INETICO reviews each network relationship to determine which wrap and
supplemental networks have the best discounts in a given area. INETICO then passes the discounts on to you. INETICO also protects you by managing disputes with providers and eliminating networks with agreements that are not clearly defined.  This is why INETICO has a 99% dispute free process within our wrap/supplemental network programs and a 100% dispute success rate for negotiated claims.

BENEFITS TO WRAP STABILIZATION AND SUPPLEMENTAL CLEARINGHOUSE :

  • Powerful extended coverage beyond the primary network
  • Superior primary network-like discounts (many Per Diem and Case Rates)
  • Strong network solution to out-of-network claims
  • Above average discounts of 25% to 35% for out-of-network claims (market dependent)
  • Deep and stable provider discounts
  • Expanded access to discounted provider services