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General Questions

Q. Who is CAI/NPPN?
A.
Coalition America, Inc. (CAI/NPPN) is a healthcare savings company
retained by payors to perform administrative services with medical claims.
CAI/NPPN coordinates
claim processing on out-of-network claims through
direct provider contracting, negotiations, fee schedule application or other
PPO discount.

CAI/NPPN has over 300 clients representing more than 12,000 businesses
nationwide, including self-insured employers, insurance companies, third party
administrators, HMOs and reinsurers. CAI/NPPN may be contacting you to
negotiate on a bill on behalf of our clients.

Q. Why should I work with CAI/NPPN?
A.
The advantages of working with CAI/NPPN 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/NPPN'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/NPPN?
A.
You may be participating with CAI/NPPN through the PPOs with which you
have chosen to contract and for which CAI/NPPN may have a direct 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/NPPN, including the name of the network partners,
if applicable.

Q. How do I become part of CAI/NPPN's network?
A.
There are two opportunities through which you can make your services
available to the members of healthcare plans supported by CAI/NPPN in your
neighborhood. To explore becoming a panel provider in NPPN's PPO network,
contact our Provider Relations Department at 866.403.8772. You also may
extend your services to our members through participation in our Continuous
Discount Agreement plan. For information, contact our Provider Negotiation
Department at 888.266.3053.

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

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.

Providers
General Questions  
EOB Remittance
Participating Provider
Status Inquiries
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