Network Strength
HealthLink, Inc. and MultiPlan, Inc. have joined forces to provide nationwide delivery
of health care products and services, with significant cost savings and administrative
ease. HealthLink offers MultiPlan’s network solutions for clients with members residing
or traveling outside the HealthLink service area. While MultiPlan’s networks are primarily
ASO/self-funded national solutions, they are also options for payors.
HealthLink PPO
Members residing in Arkansas, Illinois, southwest Indiana, Kentucky, central, southern,
eastern (St. Louis) Missouri, and the Texas regions will use the HealthLink PPO network
as the primary PPO network. The HealthLink PPO network offers access to more than 53,000
health care professionals and 750 hospitals in these service areas.
PHCS Extended PPO (Travel)
Members residing within the HealthLink service areas have access to the majority of PHCS
Network providers when they seek care outside the HealthLink service area. PHCS Extended
PPO (Travel) is a national PPO network which serves as an extension of the HealthLink
networks.
The MultiPlan Network
Some health plans include access to the MultiPlan Network, a national complementary PPO
(travel) network, which gives members an additional choice of providers at discounted
rates when seeking care outside the HealthLink service areas. The MultiPlan network
includes approximately 4,000 acute-care hospitals, 100,000 ancillary facilities and
550,000 practitioners in all 50 states. Out-of-network co-payment and co-insurance
applies.
PHCS Network
HealthLink clients with multi-sited locations (membership residing outside the HealthLink
service areas) may use the PHCS Network as the primary PPO network. The PHCS Network
offers access to more than 525,000 health care professionals and 3,800 hospitals in
all 50 states. Seventy-five percent of the client’s membership must reside in the HealthLink
service areas in order to access the PHCS Network.
Fee Negotiation Process
Clients accessing the MultiPlan (complementary PPO) Network may utilize the program’s Fee
Negotiation process to help manage non-contracted health care services costs. Through this
arrangement, negotiators work individually with non-contracted providers to obtain mutually
beneficial cost reductions. When a negotiated settlement is reached through this service,
members are not billed for the difference between the original charges and negotiated amount.
Flexible Plan Options
HealthLink, Inc. and MultiPlan have the flexibility to work with a wide range of third
party administrators, including most TPAs chosen by a contracted client. Clients may
purchase the basic PPO program package, add components on a menu basis, or purchase
a comprehensive PPO package of programs and specialty components at a special, discounted
rate. Most pricing is based on a percentage of savings. Please contact a sales representative
for pricing information.
Basic PPO Program Package Includes:
- PPO network access
- IP/OP Medical Management
- Claims Repricing
- Client Management Reporting
Comprehensive PPO Program Package Includes:
- Basic PPO Program Package
- Case Management
- Condition Management Programs
- MaterniCall™ Prenatal Program
- MedCall® 24/7 Nurse Hotline
PPO Components Available on a Menu Basis:
- Case Management
- IP/OP Medical Management
- Condition Management Programs
- MaterniCall™ Prenatal Program
- MedCall® 24/7 Nurse Hotline
- Worksite Wellness
- Lifestyle Management
- Workers’ Compensation (MO & IL)
- Specialty Programs
Specialty Programs
Through the affiliation with WellPoint, HealthLink offers a broad portfolio of specialty
programs, including: Reinsurance; Life and AD&D; Dental; Vision; and Employee Assistance
Program.
Cost Management Program
The HealthLink Cost Management Program is an extensive suite of health promotion and wellness
information, case management and care coordination services to help physicians help
their patients achieve optimal health outcomes. The program consists of three components:
Signature Services, Wellness Plus and Personal Care Resources.
Signature Services
HealthLink Signature Services include the following:
Medical Management – comprised of Utilization Management and Case Management.
The URAC-accredited Utilization Management program provides clinical review of medical necessity
to help clients determine eligibility in accordance with health benefit plan provisions. Utilization
Management includes the following components:
- Pre-Admission Certification of Planned Hospital Admission
- Notification of Emergency Hospital Admission
- Concurrent Hospital Stay Review
- Discharge Planning
- Pre-Certification of Selected Ambulatory/Outpatient Services
- Pre-Certification of Selected Ancillary Services
The Case Management program is a collaborative process among WellPoint and
other health professionals who manage the resources necessary to support individuals
with catastrophic or chronic medical conditions. Case Management enables the treating
health care professional(s) to help the patient achieve optimal and timely medical
outcomes.
Signature Services also include the following:
- Condition Management Programs – Individualized programs for members
with Asthma, Chronic Obstructive Pulmonary Disorder, Coronary Artery Disease, Diabetes
and Heart Failure.
- MaterniCall™ – Maternity management
program helps participants make informed decisions during pregnancy and after childbirth.
- MedCall® – 24/7 nurse hotline and audio library
of more than 300+ health topics.
- WellPoint NextRx – Aggressive pharmacy benefit
manager targets costs and includes a national retail network, mail order and specialty
prescription programs.
Wellness Plus
Wellness Plus includes the following programs, available on a fee-for-service basis.
Please contact a sales account representative for pricing information.
- Worksite Wellness Programs – Health educators and
registered dietitians visit your workplace to share knowledge on a variety of health
and lifestyle topics.
- Lifestyle Management Programs – On-line support
and one-on-one telephonic coaching to help members make healthy behavior choices in
five key areas: tobacco cessation, weight management, physical activity, diet/nutrition
and stress management.
Personal Care Resources
The following value-added electronic member resources are available at no cost to
clients and members:
Administrative Services
HealthLink is committed to supporting your health plan’s benefit administration through
maximum use of technology throughout our organization. We offer fast, efficient electronic
claim repricing, eligibility management, a state-of-the-art customer service response system,
a provider portal and a fully interactive web site, www.healthlink.com.
Account Management Services
Our account managers serve as liaisons between HealthLink and contracted clients. They
are responsible for the timely resolution of day-to-day service issues. Account managers
also make on-site service visits and compile/present management reports.
Management Reporting
Timely reporting tracks membership, health care services, claims accuracy, payments and
utilization.