This TrueChoice USA client is a hospital system with 41,000 members across 12 market areas. Prior to TrueChoice USA, they had fourteen (14) separate health plans covering their employee population, both fully-insured and self-funded. They worked with numerous payors, PPO networks, and other vendors. On a monthly basis, they received eligibility feeds from 28 different sources.

Corporate Objective:

1. Cost savings
2. Vendor consolidation
3. Customized network
4. Minimal data streams
5. Administrative ease

Project Steps:

1. Existing payor recommended national network as solution.
2. Consultant recommended vendor and network consolidation, with focus on selecting strong regional networks and wrapping with a strong national network.
3. TrueChoice USA selected to perform network analysis and direct provider contracting by market to create client specific network solution.
4. Review of existing medical plans and networks resulted in vendor consolidation.

Outcome:

1. Single payor, repricing solution, network management and customer service.
2. Customized network solution
1. Integrated multiple networks
2. Enhanced with client-specific contracts
3. Additional providers
4. Special, client-specific discounts
3. One data stream to the payor including:
1. All in-network repriced claims
2. Out-of-network claims both fee negotiated and non-fee negotiated
3. Single source for problem resolution.