In the midst of network innovations like Reference Based Pricing, employers seem to still prefer a national PPO network solution.
If you are a regional health plan, partnering with a national network is easier said than done. If you are not of a certain size, your calls may get ignored. If you are of a size to catch the attention of the big national networks – how do you choose?
Choosing a network based on access fees alone is not always the right solution. In a perfect world, you could have historical claims repriced with multiple networks and add in the access fees to see which network has the best combination of access and total cost. Claim repricing can be “interesting” to manage, to make sure that you are comparing apples to apples. Errors can creep in based on whether claims are repriced to historical information or based on the current payment arrangements.
Managing the comparison of multiple claim repricings with the large national networks can be an IT challenge if you do not have access to personnel experienced in the process.
But even a claim repricing comparison won’t give you a clear answer. Knowing whether cost containment measures such as pre-pay bill reviews are allowed, especially on your most frequently used out-of-area facilities, and understanding the results and the relative cost/value of PPO network mandated vendors can also be important.
We’ve seen situations where some of these steps are skipped, and the results are less than anticipated.
Having a national network for your out-of-area claims can be a big sales point. It tells HR departments that they will not have claim issues with employees.
Done correctly, using a national network can save money, increase your sales, and streamline claims processing.
If you’d like to have a no-obligation, confidential conversation about selecting a national PPO network, reach out to us at (612) 382-5094 or send an email to BradQ@DuNordRe.com if you would like more information.
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