Do You know?
- Do you know precisely what a TPA (third party administrator) is; how to identify a TPA versus a Managed Care Organization (MCO)?
- Are you clear about whether your contract with a TPA is a first, second or third tier contract? Are you familiar with the ramifications of being a first, second or third tier provider?
- Do you have the client (payer) lists for all of the TPA contracts that you have? Do you have a complete understanding of how to interpret and use these lists for the best benefit of your practice? If you do track these, have any of your contracted TPA’s refused to share their list with you? What does it mean to you when a TPA refuses to provide this information?
- Do you know what “stacking” means and how this affects your reimbursement?
- Silent PPO’s: what are they and what do they mean to you and your reimbursement?
If you don’t have the answers, you are not alone. We have done a great deal of research, phone interviews with provider relations executives and others to get a handle on these matters.
Having a clear grasp of these and other issues is not only important today, but promise to be even more important in the future, particularly as the overall national health care climate is changing due to reform. PrimeCare can guide you through this maze by informing you of the impact of all of these on your practice and particularly on your reimbursements.
Contracted Name |
Website |
|---|---|
Arcadian Health Plan |
|
Coastal Comp Health Network |
|
CorVel |
|
Coventry First Health NW & Central Region |
|
Coventry First Health SW Region (CO-TN-TX) |
|
| Evolution Healthcare Systems Guardian Resources | www.ehsppo.com |
| Focus (A Division of Coventry) | www.coventrywcs.com |
| Fortified Provider Network, Inc. | www.fortifiedprovider.com |
| Galaxy Health Network (O&P) | www.galaxyhealth.com |
| Galaxy Health Network (Complex Rehab) | www.galaxyhealth.com |
| HealthSmart-Interplan Health Group-Direct Care America(O&P) | www.healthsmart.com |
| HealthSmart-Interplan Health Group-Direct Care America (Complex Rehab) |
www.healthsmart.com |
| Independent Medical Systems | www.imedsys.com |
| Integrated Health Plan (O&P) | www.ihplan.com |
| Integrated Health Plan (Complex Rehab) | www.ihplan.com |
| Metra Comp-New York (A Division of Coventry) | www.metracomp.com |
| MSC Care Maangement | www.yourmsc.com |
| myMatrixx | www.mymatrixx.com |
| MultiPlan-PHCS (Private Health Care Systems) | www.multiplan.com |
| National Comp Care TyNet | no website available |
| National Preferred Provider Plan (NPPN) Plan Care America (O&P) | www.nppn.com |
| National Preferred Provider Plan (NPPN) Plan Care America (Complex Rehab) | www.nppn.com |
| Nova Net, Inc. | www.novanetppo.com |
| Orange County PPO (California) | www.ocfmc.com |
| Orchid Medical | www.orchidmedical.com |
| PMSI | www.pmsionline.com |
| Prime Health Services | www.primehealthservices.com |
| Progressive Medical | www.progressive-medical.com |
| Tech Health, Inc. | www.techhealth.com |
| Total Medical Solutions | www.newtms.com |
| USA Managed Care | www.usamco.com |
| Windsor Health Group | www.windsorhealthgroup.com |