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Published on: April 2008
Type of content: WHITE PAPER
Format: Adobe Acrobat (.pdf)
Length: 3 pages
Price: FREE

Overview:
FACTS® PPO™ is a fully automated provider network processing module. This system provides you with a fully integrated database for providers (both practitioners and facilities). It gives you a comprehensive system for the management and control of all aspects of provider network maintenance, including the identification of network participants and contract management. All contracts are “date-specific” driven by date of service, giving you the added capability of unlimited contract periods.

The module works in a fully integrated fashion with the FACTS® CLAIMS & ENCOUNTERS™ system. As claims are processed, FACTS PPO will automatically re-price the claim based on the specific contract that the provider had in place at the time the service was rendered. This automatic repricing interacts in an online, real-time fashion.

The key features of this system include: unlimited number of PPOs per plan; unlimited number of providers per PPO; unlimited number of PPOs and contracts per provider; per diems for all services; reimbursement schedules; provider membership with multiple networks; full physician network reporting capabilities; electronic interface capabilities; conversion, modifier and relative value calculation capability.