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Competitive Health provides an automated media on-demand solution that enables the provider and/or the patient access to real-time PPO network identification, on-demand ID card, the patient’s deductible history, patient and dependent eligibility, PPO network repricing, real-time out-of-network claims negotiation, custom network contracting, overview of patient's program and benefits, email or facsimile explanation of benefits for both the patient and the physician, XML communication to and from debit card/stored value card processing platform, payer eligibility data base and adjudication system and access to data reporting services.
The U.S. Patent and Trademark Office granted Competitive Health (CH) an important patent for its breakthrough technology used in healthcare transactions. The company’s patent, U.S. Patent 7,346,522, titled "Medical Payment System,”.
The ONLY Company in the country that has developed automated media, which includes a combination of Interactive Voice Response technology, web interface and XML push through data that enables provider's offices to:
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Explain the member's program
Customized client specific "Dear Provider" letter is communicated back to the provider's office. This is an enormous help to the provider’s office staff that is sometimes overworked and traditionally has very high turnover. The letter can also identify secondary PPO networks or negotiate a discount at the Point of Service for out of network providers.
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PPO Administration
Our patented automated system will manage multiple PPO networks by client specification. Based on the member’s eligibility, state of residence, client network hierarchy, our system will produce the demographic and fee schedule results via phone or web 24/7.
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Determine eligibility
Provider's offices want to know if the member is eligible. The system asks for the member's ID. The IVR will say one of three (3) statements, "the patient was effective on October 1, 2002" or "the patient was terminated on October 31, 2002" or the patient cannot be found, transferring to customer service. The call is then transferred to customer service center (the call can be transferred any where the client designates).
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Reprice the Claim
The only company in the country that can reprice multiple PPO networks, at the time of service, based on our client's needs. Our ability to organize PPO networks by geographic location (some PPO networks are stronger in certain areas, so many large companies utilize more than one PPO) or in order of preference.
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Out-of-Network Solutions
Out of network encounters are determined real-time. Our on-demand system can identify an out of network encounter, produce an out of network ID card with the appropriate network logo and/or offer the provider a reduced rate.
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Fax/Email Back
Our patented system will calculate the correct PPO contract rate and fax or email back to the provider's office two copies with the appropriate network logo.
This HIPAA complaint fax back service provides the provider's offices with a complete record of the transaction and an extra copy for the patient.
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Connection to Debit/Stored Value Card
Competitive Health has the technology to provide the patient and the provider the PPO contracted rate and deductible history. This “net” amount is transmitted to the processor so that the patient can pay at the time of service using their healthcare card. Many employers are now offering Health Savings Accounts (HSA/HRA) where a provider's office needs to know the net amount to charge a patient, at the time of service.
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Reports
Real-time and batch crystal reports are available. In addition, our nightly reports are posted on a secure website for our clients to view and re-create a pdf or HTML document of the transaction
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