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PHind Payor Application improves cash flow."Make the right phone call, at the right time, and follow the procedures for every payor. That will improve cash flow from contracting."The PHind Payors, Provider Health insurance national directory software system, makes it easy to reference the information and identify whom to call. The PHind Payors System provides information on over 25,000 insurers and payors, and over 1000 managed care networks. The payors in the database include exclusive provider organizations (EPO), health maintenance organizations (HMO), individual practice associations (IPA), physician medical groups (PMG), preferred provider organizations (PPO), self-funded unions or employers and other health care plans. Client-Server Database & SoftwareAll staff can simultaneously access the information with the MHIS PHind Payors (Provider Health insurance national directory) Client-Server Software. The PHind Payors™System cross references both the insurer and the managed care network(s) with which the insurer is affiliated. The type of managed care organization is provided. It is important for effective administration to know if the patient is covered by an EPO, HMO, IPA, PMG, PPO, indemnity (IND) or workers' compensation (WC) plan, or federal, state or local government program. Each type of managed care or indemnity program requires different types of administration, authorization, and utilization management. The PHind Payors System provides that information and instruction. To select a specific payor simply type in the payor's name. For example, type 'Pacificare.' The system is organized for intuitive movement to the appropriate section. Complete information is provided on whom to contact for each payor participating in a network. Addresses and phone numbers are provided for each plancode (claim's office). Appropriate instructions are provided, based upon the managed care organization classification codes. Providing medical care to patients covered by managed care requires many additional administrative steps. Knowing what to do, as well as whom to contact, is often critical for timely payment. The MHIS system organizes the information for easy access. Simply select the administrative category of interest and important reference information on the insurer's program is shown on the screen. The administration requirements for some Managed Care Organizations are very complex. Utilization management is delegated to one organization, or a third party administrator is used to pay claims. The MHIS PayorID Data Warehouse keeps track of those additional relationships in the administrative process. HMOs and medical groups have created complex relationships. Some IPAs (Medical Groups) are capitated for medical and in some cases hospital services. The PHind Payors System, and The MHIS PayorID Data Warehouse keeps track of those requirements. If several IPAs are responsible for claims, eligibility, or utilization review, the system has the contact information you need. Network Requirements & ProceduresSome payors participate with several managed care networks. Many insurers have different managed care networks for their EPO, HMO, or PPO options. Some have different networks for their health and workers compensation programs. Some payors contract with different networks for selected employer groups. The MHIS system cross references all these variations and makes it quick and easy to identify the right managed care plan.
EmployersMHIS has compiled a composite list of employers from releases of several Managed Care Organizations. Each employer is linked, by MHIS staff, to one or more plans which are offered to employees. The database can be searched by employer name. Some insurers set up relationships with different networks for selected employers. For such payors, the PHind Payors System provides which employers are in which network. The MHIS system links to that insurer and provides the information on administration of the payor's program. Moreover, if the payor has assigned specific offices or agents to handle claims, eligibility or utilization management for an employer, that information is provided. Insurance Master FileThe data from the MHIS PayorID Data Warehouse, and the client's rules tables are used to generate and update the client's insurance master file (IMF). MHIS keeps information on the financial class, payor claims offices, and other codes up-to-date. The data in the client's McKesson, IDX, Siemens or other claims and registration system(s) is updated from the MHIS PayorID Data Warehouse. Database integration with the MHIS PayorID Data Warehouse relieves the hospital of thousands of staff hours maintaining its insurance master file. The provider's contract status with each payor is shown on all the screens. The MHIS System has an optional module to input contract specific or special terms for any payor. If your facility has established unique terms and conditions with a payor or network, that information can be added to your system. For example, this module allows a Medical Center to inform its registration, billing and/or utilization management staff about special contracts it has signed with several networks. These contracts could take many forms. Global transplant package contracts or capitation contracts, which cover hospital and/or professional services, are two examples of how timely and consistent communication of requirements are critical. Registration, business office, and utilization review staff can have the contract specifics at all times. Changes and updates can be input once and automatically available to the users when they need the information. The PHind Payors System informs staff about the authorization, referral, and other administrative requirements of each payor. Key Benefits
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