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Learn more at www.AmericasPPO.com |
Think Nationally Act Locally
The commonly used term
“PPO” was coined for our
company
by healthcare
leader Paul Ellwood, MD,
in 1982.
Experience
- Minnesota’s first Preferred Provider Organization
- Now serve over 500 client and payer groups in many states
Preferred Provider Network
- Over 71,000 doctors and other providers
- Continuing direct network expansion in Minnesota, North Dakota, South Dakota, Iowa, and western Wisconsin
Negotiated Fee Arrangements
- Physicians - fee schedules and/or discount agreements
- Hospitals - per diems, DRGs, APC and other arrangements
- Other medical care providers (varies)
Quality Management
- Member and provider education
- Customer satisfaction surveying
- Customized reporting
- Provider profiling and recredentialing
Key Characteristics and Benefits
- Pricing is competitive and 100% transparent
- America’s PPO is independent; we do not buy providers. There are no hidden agendas. We negotiate our rates and the amount paid by the employer is exactly what is paid to the provider.
- Contracts are fixed. Physicians must keep their practices open to new enrollees, physicians must follow our Utilization Review (UR) standards, and physicians must precertify or be held financially responsible.
Utilization Review (UR) and Case Management
- Pre-admission hospital and pre-surgical review
- Concurrent and retrospective review
- Managed mental health program
- 100% case review by practicing physicians
- High-risk maternity screening and management
- Managed pharmaceutical program
- UR and case management available outside PPO network
