A
Single point of contact
for all Member and Provider needs
PROVIDER SERVICES
SINGLE POINT OF CONTACT FOR CLAIMS & ELIGIBILITY
Provider Claims
By connecting to TPA claim system, THG will respond to all 1st level provider claims questions and escalate issues to the TPA claims team as necessary.
Provider Eligibility
Handle inbound Provider eligibility calls, verifying Member eligibility, confirming Provider participation in underlying networks, and reviewing Member benefits.
FOR REFERENCE BASED PRICING
AND HIGH PERFORMANCE NETWORK PLANS
Creating Access
Unlike 3 year disruption reports, THG reaches out to members in the beginning of the plan year analyzing their providers against the underlying network. When providers fall outside of the underlying network, we create contractual arrangements with those non-PAR providers ultimately creating a micro-network, employer by employer.
Quieting the noise in the doctor’s office
THG’s Provider Contracting Team proactively contacts Providers ahead of Member’s scheduled appointments and provides an overview of Member Benefits, Claims Submission Address, EDI number, etc. This allows the normal claims process to occur avoiding the need for the Member to pay full billed charges at time of service.
We have nearly 100% success in getting members into the doctor’s offices that they are requesting at contracted rates that work for the plan design.