PPO Network Program
Health plans that contract with the NCPPO and HealthLink network program allow
enrollees to use any physician or facility, in- or out-of-network, and receive benefits
for covered services. Benefits are higher and out-of-pocket costs lower for medical
care received from contracted PPO physicians and hospitals.
Network Strength
The NCPPO and HealthLink network program delivers broad regional access to contracted providers who have agreed to accept
competitively discounted payments for health services. Service areas include:
Arkansas, Illinois, Missouri and Texas; and Mid-Atlantic service areas of Maryland, Northern Virginia
and Washington DC. NCPPO and HealthLink also provides a national network solution
for clients with enrollees who reside or travel outside the service area.
Competitive Discounts
Our disciplined approach to fixed payment methodologies, precise modeling/ forecasting
of rate changes and actuarial calculations allows us to establish aggressive pricing
targets by market and product.
Plan Performance Management
Our sophisticated rate modeling techniques analyze and evaluate how current market trends,
enrollee demographics and client objectives affect plan design. We make this information
available to you so that you may evaluate your health benefit program and have the
ability to recognize the cost/benefit value of changing or adding programs and services
when the time is right.
Stability
Our provider retention rate of 98% reflects the high levels of satisfaction that have become
a NCPPO and HealthLink standard.
Flexible Plan Options
The NCPPO and HealthLink network program has the flexibility to work with a wide range of plan administrators. Employers
may choose the plan administrator along with the NCPPO and HealthLink network. The NCPPO and HealthLink
network program can be integrated into company benefit plans to support any plan design.
Clients may purchase the basic PPO program package, add components on a menu basis,
or purchase a comprehensive PPO package of programs and specialty components at a special,
discounted rate. Most pricing is PEPM. Please contact a sales representative for pricing
information.
Basic PPO Program
Package Includes:
- PPO network access
- IP/OP Medical Management
- Claims Repricing
- Client Management Reporting
Comprehensive PPO
Program Package Includes:
- Basic PPO Program Package
- Case Management
- Condition Management Programs
- MaterniCall™ Prenatal Program
- MedCall® 24/7 Nurse Hotline
PPO Components
Available on a Menu Basis
- Case Management
- IP/OP Medical Management
- Condition Management Programs
- MaterniCall™ Maternity Management Program
- MedCall® 24/7 Nurse Hotline
- Worksite Wellness
- Lifestyle Management
- Workers’ Compensation (MO & IL)
- Specialty Programs
Specialty Programs
Through our affiliation
with WellPoint, the NCPPO and HealthLink network program offers a broad portfolio of specialty options, including:
Reinsurance; Life and AD&D; Dental; Vision; and Employee Assistance Program.
Cost Management
Health Care Management is an extensive suite of health promotion and
wellness information, case management and care coordination services to help physicians
help their patients achieve optimal health outcomes. The program includes three levels
of services: HealthLink Signature; HealthLink Wellness Plus; and HealthLink Personal Care
Resources.
HealthLink Signature Services
HealthLink Medical Management is comprised of two components:
Utilization Management and Case Management.
The URAC-accredited Utilization Management program provides clinical review of the medical
necessity for medical care to help clients determine eligibility in accordance with health
benefit plan provisions, and includes the following components:
- Pre-Admission Certification of Planned Hospital Admission
- Notification of Emergency Hospital Admission
- Concurrent Hospital Stay Review
- Discharge Planning
- Pre-Certification of Selected Ambulatory/Outpatient Services
- Pre-Certification of Selected Ancillary Services
The Case Management program is a collaborative process among HealthLink
and other health professionals who manage the resources necessary to support individuals
with catastrophic or chronic medical conditions. Case Management helps the treating
health care professional(s) help the patient achieve optimal and timely medical outcomes.
HealthLink Signature Services also include the following:
- Condition Management Programs - Individualized programs for members
with Asthma, Chronic Obstructive Pulmonary Disorder, Coronary Artery Disease, Diabetes
and Heart Failure.
- MaterniCall™ - Maternity management
program helps participants make informed decisions during pregnancy and after childbirth.
- MedCall® - 24/7 nurse hotline and audio library
of more than 300+ health topics.
- WellPoint NextRx - Aggressive pharmacy benefit
manager targets costs and includes a national retail network, mail order and specialty
prescription programs.
HealthLink Wellness Plus
The following programs are offered at no charge to the client or member:
- SpecialOffers Online
Discount Program - Helps promote health and well being. More than 20 third-party
vendors provide discounts on services related to family and home, fitness and health,
and vision/hearing/dental treatment.
- TLC® (The Last Cigarette) - Smoking cessation
program. Members request a TLC quit kit to assist in their efforts to be smoke-free.
The following programs are available on a fee-for-service basis. Please contact a
sales account representative for pricing information:
- Worksite Wellness Programs - Health educators and
registered dietitians visit your workplace to share knowledge on a variety of health
and lifestyle topics.
- Lifestyle Management Programs - Engaging online programs and inspiring coaches use
proactive outreach activities and support strategies to help employees in the areas
of: tobacco cessation, weight management, stress management, physical activity and
diet/nutrition.
HealthLink Personal Care Resources
The following value-added electronic member resources are available at no cost to
clients and members:
Administrative Accountability
Accurate, efficient service and support are the foundation of all NCPPO and HealthLink network programs.
We deliver results.
Administrative Services
The NCPPO and HealthLink network program supports your health plan’s benefit administration through
maximum use of technology throughout our organization. We offer fast, efficient electronic
claim repricing, eligibility management, a state-of-the-art customer service response system,
a provider portal and a fully interactive website, www.healthlink.com.
Account Management Services
NCPPO and HealthLink account managers serve as liaison between NCPPO and HealthLink and contracted clients.
They are responsible for the timely resolution of day-to-day service issues. Account
managers also make service visits and compile/present management reports.
Management Reporting Timely reporting tracks membership, health
care services, claims accuracy, payments and utilization.
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