Provider Network Solutions

Health Design Plus works closely with networks and providers to make sure that billing is appropriate, medically necessary and paid according to plan. High dollar, out-of-network claims are internally negotiated by the Provider Strategies Team at HDP on a pre-claim, concurrent and retrospective basis as a collaborative effort with Care Management. Savings achieved are provider specific and vary by provider type, however, HDP usually achieves savings above industry standard due to a high level of expertise in special claims handling and provider engagement strategies. 100% of HDP negotiations are signed off on in writing by a Letter of Agreement with the provider, and the member and patient are held harmless for the negotiated discount afforded.

Additionally, HDP offers cost containment solutions based upon each client’s unique needs, such as out of network wrap PPO access, UCR application or % of Medicare claims reduction services. These cost containment solutions can be accessed individually, or structured in a tiered program to achieve the ultimate level of medical cost savings. HDP’s efforts in this area have resulted in millions of dollars in additional savings for clients over and above those achieved through traditional network contracts.

The following network management and development services are available:

  • Medical, pharmacy, dental and vision networks
  • Contract negotiations
  • Websites and directories, listing hospitals, physicians and ancillary services
  • Ongoing network management

Network discounts provide one of several necessary steps in controlling healthcare costs. Discounts reduce the cost per unit. They do not reduce the rate of increase of costs. To achieve a reduction in the rate of increase, an effective Care Management program must be in place.