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:

• 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:

• TLC^® (The Last Cigarette) – Smoking cessation program. Members request a TLC quit kit to assist in their efforts to be smoke-free.
• eHouseCall – Monthly wellness newsletter for members.
• Preventive Health Guidelines – As recommended by the U.S. Preventive Services Task Force and other health related agencies.
• Healthy Habits for Healthy Kids – Nutrition and activity guide from the American Dietetic Association.
• Enrollee Rights and Responsibilities – General guidelines for health care consumers.

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.