EXPERTISE, COST SAVINGS AND SATISFACTION

UNMATCHED VALUE

We have specialized in rental PPO network administration for over 30 years. We have the
products, services and experience to be a true managed care partner.

OUR NETWORKS

CLAIMS REPRICING

We provide medical and dental claims repricing services to insurance carriers, third-party administrators and self-administered employer groups. Our repricing staff excels in surpassing specific turn-around goals and accuracy standards, making our process one of the most efficient and accurate in the industry.

  1. Claims are filed directly to PHP for repricing.
  2. PHP reprices according to pre-negotiated PPO rates/discounts.
  3. Original claim and the repricing cover sheet are sent to the insurance carrier, third-party administrator or self-administered employer group for benefit determination and claim payment.

PHP does not determine member eligibility or benefits. Eligibility and benefits are validated by the payor. Claims should be filed according to the instructions listed on the member’s medical ID card.

CLAIMS PRICING AND ADJUDICATION SYSTEM

PHP’s technology solutions enhance and automate complex claims pricing and processing requirements, minimizing cost and ensuring superb quality. Our proprietary claims processing platform is secure and customizable to each client. We handle development, support and maintenance so you can focus on your critical business operations. ECP™ Claims Processing Platform:

     

  • Health and work comp claims are processed in a day.
  • System is tailored to your specifications, based on your summary plan and benefit blueprint.
  • Easily accessible, anywhere you are, across the US and abroad, anytime.
  • Support, implementation and training managed by us with a dedicated point of contact for you.
  • Similar features and experience as with Microsoft Office 2010 applications.
  • Configured for HIPAA and ANSI X12 EDI guidelines.

ELECTRONIC DATA INTERCHANGE (EDI) TRANSLATION SERVICES

Our EDI translation tool allows us to create, transfer and submit your claims data electronically with ease, security and minimal cost. We also provide inbound, outbound and round trip file transfer services. By removing the complex and often labor intensive efforts in handling EDI translations, your staff can focus on core competencies and other resource intensive initiatives inside your company.

PAPER DOCUMENT CONVERSION SERVICES

Our proprietary Optical Character Recognition (OCR) process allows us to convert paper into data. Simply scan paper documents from your office and automatically upload them into our system. The data is returned to you in the desired format, including electronic images. Our low cost, high quality OCR process reduces data errors. This means you don’t have to spend your time and money dealing with issues like failed processes, pricing errors or incorrectly applied benefits.

OCR Benefits:

  • Tailored to your individual requirements and business rules.
  • Eliminates manual data entry of paper claims, cutting costs and increasing accuracy.
  • Conversions & processing completed within a day.
  • Maintain control of your paper documents and the corresponding electronic images.
  • Multiple formats available.
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