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PMCS - Whitepapers

Everything you always wanted to know about Out-of-Network Claims Expense Management....that PPO aggregators don't want you to know

prepared by: Richard L. Nicholas TPA Network

 medical claim repricing, medical claim settlement, PPO claim repricing, medical cost management, cost containment, claims repricing, out-of-network claims, repricing medical claims, medical claim savings, enhanced claim editing, claim repricing solution, funding medical claims, fee negotiations, medical claims, medical bill repricing, HIPAA, EDI solutions, claim processing management, healthcare repricing,claim processing, claim tracking system, financial claim reviews, out-of-network reimbursement, unpaid doctor bills, medical bill assistance, unpaid healthcare bills, medical debt, claim settlement, patient pay, continuous discount agreements
Table of Contents
Overview and Summary
Maximizing Provider Network Discounts
How and Why Primary and Secondary PPOs Work
Accessing Providers through Primary PPOs
Accessing Providers through PPO Aggregators
Provider Discount Abuse
Silent PPOs
Provider Network Stacking
Why Provider Discount Abuse Occurs
Why Combatting Provider Network Abuse is Important
Industry Trade Groups on Provider Discount Abuse
Legal Decisions Involving Provider Discount Abuse
Legislative Action Involving Provider Discount Abuse
How Providers are Fighting Back
Managing Out-of-Network Claims Expenses
Obtaining Out-of-Network Discounts through PPO Aggregators
Obtaining Out-of-Network Discounts through Direct-Contracted PPOs
Obtaining Out-of-Network Discounts through Fee Negotiation
Obtaining Out-of-Network Discounts through Specialty Finance Companies
About TPA Network, the Author, and this Report
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