5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739 www.payerfusenet.com1.

Slides:



Advertisements
Similar presentations
Blending Supply-Side Approaches with Consumerism Paul B. Ginsburg, Ph.D. Presentation to Second National Consumer-Driven Healthcare Summit, September 26,
Advertisements

Managing Health Insurance Risk
Ticket to Work Program. Objectives Historical Overview of the Program Current Status of the Program The Future of the Program.
Total Utility Management Services, LLC is committed to helping your organization make the best informed energy decisions with decades of cost-proven results.
Economic Relationships in Health Care Peter Farrow – CEO & General Manager –
See Vision from a New Perspective. Your Partners in Vision Care.
Introduction to 2gb2 and verifyCA TM. About the Company Extensive health care provider background Sister company to ERIS Medical Technologies (
BlueCross BlueShield of IllinoisShining Through ®′ Labor Fund Dental Network Program A Dental PPO National Network for Taft-Hartley Health and Welfare.
Medicare Supplement vs Medicare Advantage For authorized agent use only. Not for public use.
Total Care Plan Joint development of a new and effective vehicle for delivering health benefits Tim Cappel, President, Humana of Ohio William Banks – VP,
The Blue Plans, Private Insurance, and Managed Care Plans
Turn key management solutions. Challenges and Solutions The challenges of a well run marine program include a need for quality, consistency, and efficiency.
Chapter 5 Private Insurance Companies Principles of Risk Management & Insurance.
Chet Rhoads The HDH Group November 19,  83% of firms with employees offer health insurance  91% of firms with employees offer health.
BIG DATA AND THE HEALTHCARE REVOLUTION FORD+SSPG 2014.
Component 1: Introduction to Health Care and Public Health in the U.S. 1.5: Unit 5: Financing Health Care (Part 2) 1.5b: Reimbursement Methodologies and.
1 Department of Education Race to the Top Assessment Program Procurement Strategy Discussion Dr. Allan V. Burman President Jefferson Solutions
1 Health Insurance Briefing 22 July 2010 CHANGES IN THE HEALTH INSURANCE PROGRAMMES
March Sliding Fee Scales, Patients Cap on Charges Eli Camhi, MSSW – Tom Hickey -
OTCBB: ALHC RENN Capital Presentation May 15, 2009.
Copyright ©2014 by Saunders, an imprint of Elsevier Inc. All rights reserved 1 Chapter 11 The Blue Plans, Private Insurance, and Managed Care Plans Insurance.
The Basics Understanding Health Insurance Terms Jennifer Flory, HIA, CPIW, CGBA.
Michael T. Lundberg, Executive Director. 2  VHI is an independent, nonprofit, 501(c)(3) health information organization established in 1993  Formed.
Lukas Steinmann Mexico 10. June 2008 To your health: diagnosing the state of healthcare and the global private medical insurance industry.
L.L.L. Inc. Employee Benefits Consulting & Insurance Brokerage Servicing New York, New Jersey & Pennsylvania Introduction to: SELF FUNDED PLANS PLANS.
AMA’s National Managed Care Contract and Database Wes Cleveland, JD American Medical Association
International Congress and Convention Associationwww.iccaworld.com Strategic Plan – Mission Statement “ICCA is the global community for the meetings industry,
1 Outsourcing: Managing the relationship Example: Reclining chair project FIGURE 12.1.
Expense Reduction: the timing has never been better! Lycia Rettig, Director Expense Reduction Analysts
Foundation Standard Discuss common methods of payment for healthcare.
ACCOUNTING FOR HEALTHCARE Pertemuan 8-12 Matakuliah: A1042/Accounting Software Package for Services Tahun: 2010.
Methods of Payment for Healthcare
Chapter 11 The Blue Plans, Private Insurance, and Managed Care Plans Elsevier items and derived items © 2010, 2008 by Saunders, an imprint of Elsevier.
July 31, 2009Prepared by the Maine Health Information Center Overview of All Payer Claims Data Suanne Singer, Senior Consultant Maine Health Information.
Self-Funding Medical Plans. Advantages of Self-Funding What Are the Advantages of Self- Funding? –Utilizing self-funding, employers frequently find they.
Quality Based Selection The Best Practice for Selecting Professional Consultants [DATE]
1 Defined Benefit Limited Medical Plans Limited Medical plans offer employers of all sizes the most cost-effective solutions to meet the healthcare challenges.
1 Paul Gross President and CEO, Insurance Claims Management Paul has led Insurance Claim Management (ICM) since its founding. He previously served as President.
True Freedom of Choice No Networks – No Penalties Provider Freedom.
Component 1: Introduction to Health Care and Public Health in the U.S. 1.4: Unit 4: Financing Health Care (Part 1) 1.4 c: Insurance and Third-Party Payers.
Health care transformed by the power of engagement or health, happiness and money: The three things that matter most Connecting Countries through Care.
HEALTH INSURANCE PROGRAM. Health Insurance Team Members  Favorite City Manager  Human Resources  Finance  Contracts  Purchasing  Utility  Fire.
Employer-Sponsored Insurance The Search for “Value”
Private Health Insurance
California Department of Public Health / 1 CALIFORNIA DEPARTMENT OF PUBLIC HEALTH Standards and Guidelines for Healthcare Surge during Emergencies How.
Maximize Administrative Savings with an Enterprise Payment Integrity Strategy.
Pharmacy Benefit Management (PBM) 101
Alternative Risk Financing Vehicles. Began development in 2010 Launched first captive in 2011 Current Active Captive Portfolio ‒ Legacy health – Heterogeneous.
BUSINESS STRATEGY AND PLAN 2010 Emerging Energy Solutions 1.
Pursuing Economic Alignment through Value-Based Reimbursement Western Michigan HFMA Annual Reimbursement Update September 16, 2015 Richard P. O’Donnell.
THE UNITED STATES HEALTH CARE SYSTEM Combining Business, Health, and Delivery CHAPTER Copyright ©2012 by Pearson Education, Inc. All rights reserved. The.
The Role of the Employer: A Strategy for Controlling Healthcare Costs and Improving Quality South Carolina Business Coalition on Health May 10, 2016 Greenville.
Who is HPACT/Valley Schools? How do we help you save?
Chapter 8 Strategy in the Global Environment
Why Self-Funding?.
Methods of Payment for Healthcare
Program Overview.
Healthcare 101 by Steven Lash
Methods of Payment for Healthcare
Methods of Payment for Healthcare
Chapter 8 Strategy in the Global Environment
Component 1: Introduction to Health Care and Public Health in the U.S.
Ametros Overview.
MAZARS’ CONSULTING PRACTICE Helping your Business Venture Further
Pharmacy – Fully Insured versus Self Funding
Chapter 8 Strategy in the global Environment
Together, We Care More Meet MMCAP Infuse.
ON TRACK KEEPING YOUR BUDGETS
Presentation transcript:

5200 Blue Lagoon Dr. Suite #100  Miami, FL  (305)

5200 Blue Lagoon Dr. Suite #100  Miami, FL  (305) OVERVIEW PayFuseNet gives your members freedom of choice while maximizing your savings through our cost-plus methodology. Network presence established across the USA, Puerto Rico, the Caribbean, Latin America, Europe, Asia, New Zealand and South Africa. Directly contracted and managed to ensure strong provider relationships and attain the most value for our clients. Fully compliant with all USA federal and state regulations. Zero-balance billing guarantee, worry-free access to care.

5200 Blue Lagoon Dr. Suite #100  Miami, FL  (305) OVERVIEW A provider network is only as strong the connections between all parties in the healthcare equation. Advocacy on behalf of patients and plan sponsors to address care needs and maximize opportunities for cost savings. We can coordinate care in advance and work with all parties to manage claims already incurred or in process. Expertise attained through over 75 years of combined experience on all sides of the healthcare business means there’s never a situation we can’t handle. Compliance - Each claim that we adjudicate is validated relative to regulatory and compliance guidelines to ensure viability of payment based on the requirements of federal and state guidelines.

5200 Blue Lagoon Dr. Suite #100  Miami, FL  (305) PROVIDER NETWORK OPTIONS

5200 Blue Lagoon Dr. Suite #100  Miami, FL  (305) THE NETWORK WITHOUT WALLS With PayFuseNet, there is no such thing as an “out-of-network” provider. Providers are contracted on a “cost-plus” basis with a competitive fee schedule that is fair to all parties. Our cost-plus reimbursement methodology utilizes real cost & quality data to determine a fair retail price for medical services. This approach leads to fair and sustainable pricing for plan sponsors and their members.

5200 Blue Lagoon Dr. Suite #100  Miami, FL  (305) THE NETWORK WITHOUT WALLS Our approach is the key to your savings, not provider membership and discounts on inflated charges. When a member visits a provider that has not been contracted, we will invite the provider to join our network With those not ready to join the network, we will settle the claim on a cost-plus basis and offer immediate payment as an incentive to reduce the billed charges down to cost-plus pricing.

5200 Blue Lagoon Dr. Suite #100  Miami, FL  (305) COST-PLUS REIMBURSEMENT Cost-Plus reimbursement creates significant savings for plan sponsors while allowing providers a fair profit based on the actual cost of service. Each claim is compared to national data reported by state and federal agencies, as well as to our own proprietary database Utilizing this data, we determine the actual cost of service, needs of the provider to offset losses from providing under- funded care and the fair retail cost of the service provided. Our expertise and experience on all sides of the healthcare industry gives us an invaluable advantage in negotiating effectively and maintaining long-term relationships.

5200 Blue Lagoon Dr. Suite #100  Miami, FL  (305) COST-PLUS REIMBURSEMENT Rather than pursuing discounts on continually inflating prices, we leverage real cost and quality data, mined with our own unique algorithm to achieve superior and fair pricing.

5200 Blue Lagoon Dr. Suite #100  Miami, FL  (305) PAYFUSENET VERSUS PPO PPO networks simply do not address the realities of today’s policies and the new challenges of the healthcare landscape. PPO’s were designed for policies that are PPO in nature which carry differentials and incentives for in & out of network access. These networks are now being used as a desperate means to achieve discounts on highly inflated retail prices. PPO networks are not concerned with the true cost of healthcare services. With PPO networks becoming so extensive, the concept of “discount for volume” is nonexistent. Without this leverage, PPO networks cannot effectively control billed charges and chase discounts on inflated prices that continue to increase.

5200 Blue Lagoon Dr. Suite #100  Miami, FL  (305) KEY ADVANTAGES PayFuseNet is designed to meet challenges and changes of today’s healthcare environment. Specifically developed for self-funded employers and international insurers seeking the freedom of an open access plan without the premium price. Our approach removes all network barriers because the reductions achieved are not contingent upon provider network membership.

5200 Blue Lagoon Dr. Suite #100  Miami, FL  (305) KEY ADVANTAGES PayFuseNet focuses on the needs of all parties in the healthcare equation- payer, patient & provider! Our cost-plus reimbursement methodology combined with innovative claims administration strategies results in the fair and stable pricing of healthcare services. We provide plan sponsors and members with the highest level of customer service to ensure a hassle-free and positive experience

5200 Blue Lagoon Dr. Suite #100  Miami, FL  (305)