Q. Who is CAI?
A. Coalition America, Inc. (CAI) is a healthcare savings company retained by payors to perform administrative services with medical claims. CAI coordinates the repricing of medical bills using appropriate PPO fee schedules, as well as negotiations on out-of-network bills.

We are not a PPO ourselves, but rather we manage and integrate over 100 PPOs on behalf of our clients. CAI has over 300 clients representing more than 12,000 businesses nationwide, including self-insured employers, insurance companies, third party administrators, HMOs and reinsurers.
CAI may be contacting you to negotiate on a bill or bills on behalf of its clients.

Q. Why should I work with CAI?
A. The advantages of working with CAI are numerous and include 1) the elimination of the need for further bill review by the payor; 2) reduction in valuable time generating calls concerning payment status; 3) the patient's responsibility will be reduced, which may expedite their payment of co-payments and/or deductibles.

Q. What is the patient's responsibility?
A. The patient will still owe their co-payments and/or deductibles and coinsurance in relation to the reduced payment amount. Additionally, if the plan does not cover specific services and/or charges as billed, payment will be made according to the plan language and scope of benefits.

Q. What will the total check amount be for a negotiated claim?
A. Payment amounts offered on the negotiation proposal letter are the total payment amount, less the patient responsibility reflected on the EOB. The payor listed on the patient's identification card will be able to tell you their responsibility, if any, on a claim.

Q. What is the turnaround time for payment on negotiated claims?
A. Please contact the payor or plan administrator for payment timelines (unique to each payor). The contact information can be found on the patient's benefits card or through their employer. CAI's goal is to help the payment process by eliminating the need for further claim review which could result in a delay of payment.

EOB Remittance

Q. I do not recognize the PPO name listed on the EOB, who should I contact?
A. Please call the payor, or contact our Provider Relations Department at 888.266.3053.

Q. I have a question about a discount taken, who should I contact?
A. Please call the payor, or contact our Provider Relations Department at 888.266.3053.

Participating Provider

Q. How am I participating with CAI?
A. You may be participating with CAI through the PPOs with which you have chosen to contract and for which CAI may have an access agreement. Alternatively, we may be accessing savings through a Continuous Discount Agreement (CDA) signed by a representative at your office authorizing discounts for our clients. The EOB that you receive with the payment should identify how you are participating with CAI, including the name of the network partners, if applicable.

Q. How do I become part of CAI's network?
A. CAI is not a network. CAI does have the ability to negotiate with providers for ongoing services for all of our payor clients that may be utilizing your services. If you are interested in this type of arrangement, please contact 404/459.7201 x.5247. Additionally, we can forward your information to the appropriate PPO to contact you for inclusion in their network.

Status Inquiries (must be made with the payor, not with CAI)

Q. How do I check the status of a claim or payment?
A. Please contact the payor or plan administrator. The contact information can be found on the patient's benefit card and/or through their employer.

Q. Who do I call for patient eligibility, benefits, pre-certification, or payment status?
A. Please contact the payor listed on the patient's identification card.