Primary PPO Administration

United Claim Solutions (UCS) has drastically changed how payors access PPO Networks. The UCS approach to Primary PPO Network administration begins with identifying the best Primary Network at the member level. This process allows payors to maximize in-network provider utilization by their members and increase savings through PPO network partners. All of this is completed on a Per Employee - Per Month (PEPM) basis. A number of UCS clients choose to outsource their PPO relationships, so they can focus their attentions on driving new business as well as providing the best possible service to existing clients. We run disruption analysis with geographic reporting in order to identify which network provides the best access, coverage and discounts available to your groups and members. We are able to offer a large array of national, regional and local networks to our partners. To optimize savings, these comprehensive reports can also pinpoint specific members that may require alternate primary network access.

Wrap and Supplementary Networks

UCS employs a unique method to maximize claim savings that fall out of the Primary PPO network by repricing through wrap and supplementary networks. Our program captures the large majority of non-par claims and provides powerful extended coverage beyond the primary network. These non-par claims will receive discounts comparable to the primary network discounts. We offer Expanded Savings (Out of Area Program with network steerage and logos) and Immediate Savings PPO Repricing (Retrospective non-logo repricing). UCS partners with the strongest national and regional PPO networks in order to provide payors with the highest level of access and discounts for claims outside of the primary network. With no dollar thresholds, we accept every medical bill.

Out-of-Network Negotiations

At UCS we have made a substantial investment in technology that enables us to deliver the largest negotiated discount rates in the industry. We use the most comprehensive resources, including DRG, Medicare, Reasonable & Customary, Prevailing Rates, and Continuous Provider Agreements to improve claim savings. Our highly trained negotiators realize the importance of building trust through long-term relationships with both providers and facilities. 100% of negotiations are signed off by the provider or facility, with no balance billing to the patient.