Leading PPO Management System
When it comes to PPO Network choices and support services StrataCare sets the bar. StrataCare provides industry leading network access and automation to both software and service center clients. Our multiple PPO management system is an integral part of achieving greater savings for our clients beyond fee schedule. Savings can be enhanced even further by directing care to the most cost-effective providers and hospitals, utilizing our web-based lookup tool ProviderKey(note link).
By forming strategic partnerships in local, regional and national areas, StrataCare is able to provide and administer any PPO network chosen by our clients, including clients' own, efficiently and accurately. We can apply a client's predetermined PPO Mosaic or work with clients to customize PPO coverage to fit their needs. This maximizes PPO penetration and client savings. We also provide a number of support services including PPO analysis, program results, MPN administration, etc.
Bills subject to a PPO discount are automatically re-priced through the StrataWare.NET bill review software. Hospital contract rates are displayed on-line in data entry prior to entering procedure code data. This method of front-end processing ensures the accurate application of inpatient per Diem rates, stop losses, and/or exclusions. Bill review and PPO clients have the benefit of a single-source solution with consolidated reporting and bill tracking.
Current PPO Networks
StrataCare currently has relationships with a wide variety of PPO networks. The PPO networks that StrataCare currently administers include:
- Aetna
- Beech Street
- BestComp
- Blue Cross CA
- CCN
- CHN
- CompPartners
- Employer's Choice Network
- Express Scripts
- First Health
- Focus Healthcare Management
- HealthLink
- HFN
- Indiana Health Network
- Interplan
- Ohara
- Ohio Comp Network
- Pacific Foundation
- PPOM
- Premier WorkComp Management
- Prime Health Services
- Rockport Healthcare Group
- Sierra Health Care Options
- Tennessee Healthcare
- TLC Advantage, L.L.C.
As an independent company StrataCare and CareSolutions has no ownership affiliation with its PPO partners and can provide objective analysis of network coverage.
MPN Support
StrataCare has built a unique solution to support clients choosing to use an MPN. StrataCare's extensive experience working with and maintaining PPO networks has been invaluable in developing a solution that pinpoints and addresses the challenges of administering an MPN.
The system is fully integrated within StrataWare.NET, allowing clients to manage all of the features of their MPN solution, including administering clients' own uniquely developed MPNs and PPO network based MPNs. StrataCare has an established standard EDI process for loading and maintaining MPN demographics. Additionally, MPNs are linked to applicable PPOs to obtain the appropriate network discounted rates for participating providers where applicable.
Key Features and Benefits include:
- Flexibility allowing a client to administer more than one MPN, if they certify more than one MPN for their claims
- Applies user defined processing parameters for comprehensive control
- Links MPN claims to appropriate MPN network
- Provides MPN specific reporting capabilities
- Supported by eReview process for electronic bill submission and increased review efficiency
Current MPN Networks
StrataCare supports our clients' certified MPNs in California and continues to expand these relationships to meet our clients' needs. StrataCare's current MPN networks include:
- Blue Cross CA
- First Health
- Focus Healthcare Management
- Interplan
- Medex Healthcare
