Affiliated Network Repricing - Devon Health Services

Payors and groups may purchase Devon Health Services affiliated network access to augment the coverage for NCPPO business managed by NCPPO/HealthLink. HealthLink provides the claim repricing function.

To successfully implement Devon affiliated network repricing:

• The payor's ID card should identify NCPPO and Devon logos. The Devon network ?wraps? around NCPPO for the business managed by NCPPO/HealthLink. Payors may list under the Devon logo ?for DE, NJ, NY and PA?. Provider claim mailing instructions should state EDI #90001 and to send all par claims to NCPPO/HealthLink at P.O. Box 419104, St. Louis, MO 63141-9104.
• The repricing system will be set to reprice NCPPO affiliation first, then Devon Health Services affiliation second. This means that for the few par providers overlapping between both networks, NCPPO will be primary.
• The payors will need to set their own system (using network IDs) to send provider payments to NCPPO for NCPPO par providers, and to Devon providers directly for Devon par providers.
• The claims will be repriced using the repricing organization identifiers as follows:
  • NCPPO Medical 90001 0002
  • Devon Health Services 90001 0058
• The payor programs for the EOB remarks corresponding with the codes/designations above.
• Claims will appear as ?par PPO? using 12 in SBR09 in ANSI loop 2000B.
• Payors and/or groups must have a special contract in place for Devon Health Services affiliation managed by the NCPPO and HealthLink. The current access fee rate is $5.25 PEPM for groups with NCPPO and Devon. Payments are made to NCPPO at P.O. Box 790129, St. Louis, MO 63179-0129.
• Payors must include the Devon wrap designation on group notification forms sent to NCPPO/HealthLink.
• Devon Health Services participating providers are listed on the Devon Health Services website www.DevonHealth.com (see provider finder function). (Pre-published directories are not available).
• For payors needing a Devon par file to administer the PPO business properly, the par file is a full file, comma-delimited format, available via FTP on our server (with password) on the 2^nd to last Wednesday each month. Devon specialty codes are used on this special par file.

Par file documentation and camera-ready logos are available (after contracting for Devon affiliation) by contacting your account manager.

 

National Capital Preferred Provider Organization, Inc. ("NCPPO") is a Maryland corporation. HealthLink®, Inc., is an Illinois corporation. Both are organizers of independently contracted provider networks, which are made available by contract to a variety of payors of health benefits, including insurers, third party administrators or employers. Neither has control nor right of control over the professional, medical judgment of contracted providers, nor are they liable for any acts or failures to act, by contracted providers. Neither is an insurance company and neither has liability for benefits under benefit plans offered or administered by payors. HealthLink® is a registered trademark of HealthLink, Inc. Both companies are subsidiaries of WellPoint, Inc.