CAI

  

PPO

Out-of-Network Medical Bill Discounting		  


Yes

Through Wrap PPOs, multiple Supplemental PPOs and direct negotiations.

  


Not Usually

Most networks provide only Primary PPO repricing. There are a few that will act as a wrap to existing Primary PPOs.
 

Primary PPO Management Providing Access to Key PPOs in Each State  

Yes

CAI offers access to over 100 Primary PPOs nationwide. Through a detailed unbiased analysis we can develop a customized "national" network made up of the best PPOs for coverage AND savings in each market. CAI manages the relationships on your behalf.
 

 

No

Provide access to their PPO only and any leased relationships they may have in certain markets. You may be required to contract with multiple PPOs to gain access in all markets for your covered members.
National Travel Network Reflecting Key PPOs in Each State  

Yes

CAI's national Travel Network enables you to direct employees and covered members to in-network providers anywhere in the country.

  

Not Usually

Typically will sell their PPO in all markets even when the coverage may be minimal. Smaller PPOs may not have any options for coverage outside their geographic service area.
 

Negotiations With No Minimum Requirements  

Yes

All medical bills not discounted through a PPO are automatically forwarded to our Negotiations department. Our technology enables us to discount ALL size medical bills, rather than setting "minimums" on savings opportunities.
 

 

No

Typically do not offer negotiations, requiring the client to contract separately for that service.
Detailed Savings Analysis on In-Network & Out-of-Network Bills  

Yes

This can be used as an "apples to apples" comparison of existing solutions to determine the increased savings opportunities through CAI.
 

 

No

Can potentially show savings through their network but cannot generate a savings analysis for in-network and out-of-network claims.
Streamlined Solutions for Repricing In-Network & Out-of-Network Bills  

Yes

CAI offers a variety of repricing options including Internet, EDI and paperless solutions.

  

No

Typically receive claims directly from provider to reprice or require the client to send claims via Internet, modem or fax. Some may have ability to EDI connect.
 

Single Point of Contact for Primary & Supplemental Repricing  

Yes

CAI acts as the one-stop solution for in-network and out-of-network repricing, including negotiations.

  

No

They are one PPO and may provide either in-network or out-of-network repricing for a client but not both.
 

Verification of Provider Data  

Yes

CAI uses sophisticated proprietary software that enables it to "scrub" the provider data to eliminate as many duplicates and miscoded providers as possible.

  

Maybe

However, CAI has found in its role as a PPO integrator that the majority of networks including the large national organizations are not consistent in their data hygiene programs, which could result in repricing errors when contracting directly.
 

Fees   Percentage of savings for out-of-network medical bill discounting. Percentage of savings and PEPM for Primary PPO management (depending on the size of the account). There are no additional transaction fees for utilizing our services.   Typically charge PEPM access fee and separate repricing fee. May offer percentage of savings as well.