Managing Your Health Benefit Plan

Fully-integrated Services.  Primary PhysicianCare utilizes the most advanced technology and expertise in the industry to provide fully-integrated service.  Our services encompass every aspect of medical plan administration—from assistance with employee enrollment to stop-loss insurance placement and billing.  Most importantly, all of our services are supported by members of our dedicated client services team, who offer advice on day-to-day plan management needs. 

The following is a small sample of the services made possible by Primary PhysicianCare's fully-integrated approach:

• Claim and eligibility administration
• PPO network administration
• Data management and reporting
• 24-hour access for members at www.primarypc.com
• Medical and prescription plan analyses and cost projections
• Consolidated billing of fees and ancillary products
• Stop-loss tracking, claim filing and reporting
• COBRA and HIPAA administration
• Many additional services

 

Cost Containment

Reduction of Claims Costs.  Since claims represent the majority of medical plan costs, Primary PhysicianCare utilizes an array of approaches to lower costs associated with the claims-administration process.  By combining our sophisticated claims processing system, prepayment auditing software, and quality assurance, Primary PhysicianCare produces tangible savings for our clients.  These approaches include:

• Verifying network status prior to treatment
• Implementing out-of-network strategies
• Investigating questionable claims
• Pursuing subrogation and claims recovery opportunities
• Surgical up-coding/code unbundling

 

Integrated Care Management

Seamless Infrastructure.  Our core philosophy is to provide first-rate, fully-integrated service.  This integration is crucial, particularly between plan administration and care management.  Members can rely on Primary PhysicianCare to relay information seamlessly within our infrastructure.  From the identification of hospitalization requests to the provision of in-network options, Primary PhysicianCare is dedicated to communicating efficiently.

Auto-adjudication

Sophisticated Adjudication.  The core of Primary PhysicianCare's claims system, DST Health Solutions' PowerSTEPP, is a highly sophisticated adjudication engine.  Experienced analysts identify and code all plan provisions, with subsequent claims entering the system electronically.  Those claims that do not pass auto-adjudication are designated with a hold code for auditor review.  The result is increased accuracy and efficiency.

 

HR Portal

Administrator Access and Control.  As part of our fully-integrated service, administrators are granted 24-hour access to a comprehensive online plan management tool.  Our HR portal allows HR and benefits administrators to:

• View and modify employee/dependent eligibility
• Add or terminate employees or dependents
• View claims status with online check/EOB copies
• View member deductibles/out-of-pockets
• View Flex balances
• View Flex claims
• Request ID cards
• Run online reports

Member Portal

Take control of your health, 24-hours a day, 7 days a week.  Primary PhysicianCare has developed a member portal with and integrated Personal Health Record. This online portal grants members single-site access to thier personal health information, useful benefit plan and wellness tools, and more. Primary Physician makes it easier than ever to take control of your health

Here is a sample of the invaluable information available on the member portal

• Member demographics
• Claims history
• Prescription drug history
• Current medical conditions
• Medications
• Flex claims
• Flex balances
• Prescription drug history
• Symptoms
• Health Risk Assessment
• Family health history
• Test results
• Health library
• Health videos

Provider Portal

Primary PhysicianCare has developed a provider portal for healthcare providers to access information they need to provide prompt medical care at the point of services. This portal provides secure access to the following items;

• Member eligibility verification
• Member Benefits and PPO affiliations
• Claims history and claims status
• Online Pre-Authorization (Pre-Certification)