Holland PHO is a physician hospital organization. Below is a list of services you receive as a Holland PHO member, as well as a description of the corresponding benefits. We encourage you and your staff to utilize these services to the fullest extent, thereby maximizing the value of your Holland PHO membership.
SERVICE |
BENEFIT |
- Provide information on payor plans to providers
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Providing payor information enables provider office staff to correctly interpret benefits, reducing errors when submitting claims. This, in turn, increases the likelihood that claims will be paid promptly and correctly. |
- Analyze HMO payor data, communicate findings, and assist providers in achieving performance and quality benchmarks
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Review of clinical quality and cost performance provides opportunities to address issues and develop strategies (e.g. development of practice guidelines) to ensure high quality, cost-effective care. High quality, cost-effective care increases the potential for providers to perform well financially. |
- Support clinical pathways for medical community
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Development of best practice guidelines ensures consistency in the quality of services provided to patients while, at the same time, eliminating unnecessary procedures and delays. |
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The PHO serves as an advocate for providers in resolving difficult claims issues the offices are unable to resolve on their own, enabling them to receive correct payment for services rendered. The PHO also notes trends and brings these to the attention of plans and TPAs, enabling correct payment of claims to occur. |
- Resource for provider offices
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Offices view the PHO as a trusted resource of information on a variety of healthcare and health insurance issues. We are often able to provide requested information, eliminating further time expended by office staff to search and obtain it elsewhere. |
- Provide educational opportunities to office staff
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The PHO brings in, at a minimal to no cost to offices, seminars that have addressed areas of interest, such as HIPPA, Corporate Compliance, customer satisfaction and accounts receivable management.
The PHO sponsors information/orientation sessions for offices when new contracts are activated. |
- Sponsor CME educational sessions for physicians and other providers
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Grand Rounds and Clinical Updates for Physicians are some of the Physician CME programs sponsored by Holland Hospital and the PHO. |
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The quality of physician membership is ensured through the application of NCQA credentialing standards. The PHO is delegated credentialing by several of our contracted plans, thus eliminating the need for physicians to provide duplicate documents for separate plan credentialing. |
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Practice manager, biller and physician newsletters are a source of information about various contracts and PHO committees. |
- Contracting—Assessment and negotiation of terms and legal review
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A full assessment of potential contracts is provided using PHO Board-approved standard non-financial terms guidelines. For selected contracts, the PHO negotiates to achieve an optimal contract, which is then reviewed by legal counsel. Providers are thus assured that the contracts they sign have been fairly negotiated and have no hidden pitfalls.
The PHO provides a web-based fee analysis tool, Valence, to members to assist them in evaluating the impact of proposed payor fee schedules on their practice. |
=Password Protected. Contact Heather Eizenga at (616) 355-3885 for more information.
