As a healthcare provider, participating in a PPO network has its benefits…and its costs. In fact, hospitals lose more money on workers’ compensation claims due to unfair managed care contracts than for any other reason.
You might be wondering if you’re getting the best rates with your existing networks. Or maybe you’re thinking of joining a network, but you’re not sure if it’s the right choice for your organization.
Navigating managed care contracts isn’t easy. When you partner with EnableComp, you don’t navigate it on your own.
Our Managed Care Team works with your Managed Care department to review, negotiate, and advocate for the best rates and reimbursements for your workers’ compensation claims.
As an EnableComp client, our Managed Care Team works for you at no additional cost.
A Winning PPO Network Strategy
PPO networks want a discounted rate. Providers want PPO network referrals. Unfortunately, many providers lose money on those referrals because they accept rates that aren’t right for their organization. We don’t let this happen to our clients.
We partner with you to make sure your managed care contracts provide maximum ROI for your organization.
We’ll Keep an Eye On It
Our team models all current state and payer fee schedules within E360 RCM™, our AI platform, to make sure reimbursement rates are up-to-date and accurate. Your contracts are also built into your organization’s E360 RCM™ account.
Using this information, our team is able to continuously monitor and analyze your claims. If we see that you’re being negatively impacted by steep fee schedule reductions, we’ll let you know, and we’ll make recommendations that put you back on the right path.
Take Control of Lost Revenue With a Partner Who Knows How to Find It.
Schedule a ConsultationRelationships Make the Difference
We have strong relationships with regulatory agencies, hospital associations, and trade groups in key states, as well as large PPO networks and payers.
When PPO networks know you’re our client, it opens the door to negotiations. As a client, you’re also less likely to be excluded from the network, which can be particularly important for providers who want to be included on workers’ compensation physician panels.
It’s up to us to make sure your contract is fair. Our relationships help make it happen.
Dispute Resolutions
When it comes to workers’ compensation claims, each state has its own way of handling dispute resolutions. We know all of the rules for every state, and our Managed Care Team handles the dispute resolution for you.
Advocacy for the Greater Good
It’s more expensive to treat a work injury than a regular injury. States that either use, or are considering using, CMS reimbursement models often don’t take that into consideration, and healthcare providers are paying the price.
That’s why we advocate for our clients — and all hospitals — at the state level.
We work with hospital associations to give voice to the needs of hospitals. We bring data and information to lawmakers and decision makers that demonstrate the impact of proposed fee schedule changes on a hospital’s ability (and willingness) to care for workers’ compensation patients.
Our Managed Care Team has had great success in affecting positive change for all providers with fee schedules in many states, and we’ll keep on fighting on your behalf.
