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Payment Solutions |
| By using the established framework of the Prospective Payment System (PPS), health plans share the risk with their provider network, making each group is accountable for that portion of risk that they can effectively manage. |
Benefits
- Shift appropriate levels of risk back to providers
- Reward the providers delivering effective care
- Control utilization
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Products:
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Commercial PPS Methodologies
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Using Ingenix solutions, payers are leveraging the established framework of Medicare’s Prospective Payment System to decrease the cost of care. This strategy enables payers to “pay as Medicare” pays, which can reduce in-network reimbursement costs by 25 percent. |
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Medicaid PPS
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The Ingenix PPS library includes over 20 State Medicaid PPS, the largest in the industry. States continue to adopt PPS to manage their Medicaid programs and Managed Medicaid payers implement to support state reimbursement models. |
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Medicare PPS
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Implement Medicare rules to support Medicare Advantage and other contracts based on Medicare PPS methodologies. More accurately reimburse out-of-network (OON) claims at Medicare rates, rather than paying uncontrollable percent-of-charge rates. |
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Questions?
To discuss how we can help your organization, please contact us:
engage@ingenix.com or
(800) 765-6713 |
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