NCPPO PPO Overview


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National Capital PPO

National Capital Preferred Provider Organization (PPO) network program offers access to a broad network of physicians, hospitals and other health care professionals who have agreed to provide health care services at negotiated, discounted rates. The PPO program also offers your plan members the freedom to choose out-of-network practitioners at a reduced benefit level.

TAKE A CLOSER LOOK

Broad PPO Network. National Capital PPO network is geographically and specialty balanced to ensure convenient access to contracted health care services. The program is offered in Maryland, District of Columbia, Virginia, West Virginia Delaware and portions of New Jersey and Pennsylvania.PPO members have the freedom to choose any physician or health care facility, in or out-of-network, and in any state in which we do business. However, network physicians and facilities have agreed to accept discounted rates of reimbursement for covered treatment, so your members who receive medical care within the PPO network have lower out-of-pocket costs and may receive higher benefits for covered services than if their medical care is received outside the network.

Claims Coordination. NCPPO provides claim repricing to PPO clients. A pricing sheet report is produced for every claim processed. The report serves as a check to verify that charges are consistent with Medical Management findings and applicable negotiated rates. NCPPO works with regional and national electronic claim vendors. We maintain an electronic bulletin board for convenient updates to eligibility and network files between NCPPO and third party claims payors. Our goal is to provide clients with efficient, accurate claim administration support.

Responsive Customer Service. All NCPPO programs are supported by our service-driven philosophy. We build our programs around the needs of our clients and we support the programs with efficient, informed, accessible service. We offer toll-free customer service assistance to your members.

Flexible Plan Design and Funding. While each of our programs includes a standard set of services, we can also customize benefit and service options to meet specific needs. We offer fully insured and self-funded options through insurance carriers.

Client Management Reports. NCPPO's management reports illustrate utilization patterns and the effects of plan design and network discounts on health care costs. The documents also provide comparative information that illustrates key performance benchmarks among NCPPO customers in similar industries. Reporting services also may include quarterly client meetings and monthly expense reports.

Effective Managed Care Services

Providing a fully integrated system of quality, cost-effective managed care services is our highest priority. We believe that active collaboration with purchasers and benefit administrators provides the best results. The following is the standard distribution of responsibilities. Actual assignment of these functions may be customized according to the needs of the purchaser.

NCPPO
Network management
Program installation
Claim repricing
Eligibility maintenance
Member ID card (optional)
Directory distribution
Toll-free customer service (network information)
Client reports/meetings

Benefit Administrator
Claims adjudication and benefit administration
Eligibility management
Eligibility - initial and consistent updates
Toll-free customer service (eligibility and benefit information)
Plan documentation/compliance
Coordination of pre-enrollment activity

PPO QUICK FACTS

Network Service Area
Maryland
District of Columbia
Virginia
West Virginia
Delaware
New Jersey (portions of)
Pennsylvania (portions of)

Networks
PPO
Out-of-Network Option
Self-Referral
Discounted Fee-for-Service Arrangement
Pharmacy Network (optional)

Administrative Services
Claim Repricing
Client Management Reports
Toll-Free Customer Service

Funding Arrangements
Self-funded and fully insured options are available through insurance carriers.

We Work for You - Integrated Managed Care Services from NCPPO

Start with NCPPO.
Select additional health care programs from NCPPO.
Add CompManagement - a program that meets Workers' Compensation needs.
Benefit from integrated programs and services - Claims repricing and
health care documentation - all literally built in to NCPPO's managed care system.

The result is 24-hour protection for plan participants - and 24-hour risk management for employers and labor organizations.

Thursday, August 28, 2008

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Freedom of Choice

Broad Network with Discounted Fee-for-Service Negotiated Rates

Claims Coordination

Toll-Free Customer Service

Flexible Plan Design and Funding

Client Management Reports

Optional Pharmacy Network

Full Integration with all NCPPO Managed Care Systems



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