Our PPO Negotiation Step by Step Process
Guaranteed to Save You Money
Analyzing the percentage of the practice’s patient base that is participating with the each PPO group and identifying the top 5 insurance groups holding the highest patient count. This becomes important when comprising a strategy in step 5 in order to leverage the top 5 payor groups to obtain the highest claim reimbursement possible.
To ensure our evaluation is accurate and negotiations are effective, we analyze the practice’s current UCR fees and compare it to fees of dental practice’s in the same zip code location. In addition, we review Your current fee schedules directly from each PPO insurance company.
Due to the ever-changing and confusing relationships between many PPO companies, many dentist’s can find themselves being paid under new fee schedules or through plans they’re not familiar with. We ensure that your participation is mapped out clearly and optimized in order to produce the optimal amount of patients at the highest rate of reimbursement.how your practice is in network with 14+ major insurance groups, either directly or through a rented network, and present findings in a GoToMeeting.
Upon accepting your Negotiation Plan, our team of experts will negotiate with our vast list of contacts at each major PPO insurance company in an effort to raise your reimbursements. With our combined experience and dedication, we strive to obtain the highest reimbursements possible. Negotiating higher fees in the networks that would make the greatest impact, and present our findings to you in a GoToMeeting
Similar to a treatment plan, we create an in-depth report outlining what we’ve found from our analysis. This report includes a map of your participation, a list of top employers for your zip code, a detailed analysis of each fee schedule, and a negotiation plan, and what we can do to help improve your PPO revenue. We strategically lay out a Game Plan that will increase the practice’s reimbursement on claims, while minimizing the number of patients the Game Plan will be affecting. We schedule a GoToMeeting to review the information and address any questions you or your team may have.
Our team will complete the credentialing forms properly to avoid any delays and continue to monitor until the Dentists are safely “IN-NETWORK”. the monitoring process is just as important as having a correctly completed application. During this step we make sure the rented networks obtain notification through the TPA system to ensure the associates are seen in the correct network and under the correct fee schedule.
It is critical we monitor the implementation of the game plan in order to meet the projected project completion date. Very often we have found the redentialing department will delay or fail to notify the proper departments of any issue surrounding the credentialing process. This often time slows down the progress of the project and prevents the practice from meeting it’s target date of completion.
It is very important that you and your team learn how fee reimbursements are affected by how the practice participates with various rented networks. We teach this process in GoToMeetings scheduled during each phase of the project so the information does not become overwhelming. We then instruct the account managers on how to monitor and hold the the insurance companies accountable by teaching them certain line items they need to pay special attention to when reviewing the EOB’s and calling on elgibility.