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Q. Is Coalition America, Inc. (CAI) A Preferred Provider Organization
A. Coalition America, Inc. provides comprehensive solutions for managing
healthcare costs. CAI utilizes a suite of products and services including direct
provider contracts, PPO networks and provider negotiations to achieve industry
leading savings for its national client base of health insurance carriers, self
insured employers, Taft-Hartley plans and third party administrators.
Q. Can CAI Provide Access To A Full Range Of Providers?
A. Yes. CAI has contracted with PPOs offering a full range of services,
from physicians to ancillary providers, from hospitals to hospice
care. Additionally, we have access to transplant facilities and Centers
of Excellence through multiple PPO partners.
Q. Does CAI Discount Out-Of-Area And Out-Of-Network Medical Bills?
A. Absolutely. CAI is the leader in medical claim savings, specializing
in discounting out-of-area and out-of-network medical bills for group
health and workers' compensation plans. We utilize a unique four tiered
approach of Wrap PPOs, Supplemental PPOs, Continuous Discount Agreements
(CDAs) and negotiations on ALL size claims to generate the greatest
Q. Is CAI A "Silent" Or "Blind" PPO?
A. No. A "silent" or "blind" PPO or repricing
organization provides discounts on medical claims without meeting
the requirements of their PPO partners (example; the contract with
a PPO requires that a minimum of 10% benefit differentials must be
in place to access a discount, however the vendor takes the discount
on a patient who is not proactively directed to the provider for care).
CAI only uses those PPOs that BY CONTRACT authorize us to access discounts
when the patient is not directed to the provider for care or otherwise
meets the requirements of the provider. Typically, we can access 5-13
Supplemental PPOs in each state. There are some organizations that
do engage in "blind discounting" behavior and we caution
companies to confirm their vendors contractual relationships with the PPOs
or providers. Taking discounts inappropriately can lead to provider disputes, lost discounts and
Q. How Do I Determine If CAI Can Provide Significant Savings For
A. Easy. Let CAI perform a detailed savings analysis. Utilizing a proprietary
system called VIPER, CAI analyzes specific provider information to
provide an "apples to apples" comparison of the savings
we can generate compared to your current solutions. We will provide
realistic estimates of savings through Primary PPOs, as well as savings
on out-of-area and out-of-network medical bills, all based on historical
experience, not "guestimated" savings percentages.
Q. Is CAI HIPAA Compliant?
A. Yes. CAI has established HIPAA compliancy programs for privacy.
Additionally, we have created several HIPAA compliant electronic data
interchange (EDI) mechanisms that can enable our clients to meet HIPAA
security standards with very little time and effort on their part.
Please see our HIPAA statement under "About Us" on our website.
Q. Does CAI Offer Real-Time Claim Repricing Services?
A. Yes. CAI led the market by offering the most user-friendly Internet
repricing system available, RepriceNow. This system provides claim
repricing in seconds without entering the complete HCFA or UB. Additionally,
we offer a state-of-the-art XML repricing solution that allows our
clients to receive real-time repricing through an automated solution.
Q. Does CAI Offer Electronic Data Interchange (EDI) Solutions?
A. Yes. CAI has several EDI options to meet the varying needs of its
clients. From HIPAA compliant direct 837 connections, to more sophisticated
"paperless" solutions that reduce or eliminate mail room
and data entry costs, we have what you need.
Q. What Is The Standard Turnaround Time (TAT) For Claim Repricings?
A. The standard TAT for PPO claim repricing is typically seconds for
claims repriced through RepriceNow for providers within our loaded
PPOs. For clean EDI claims the turnaround is typically one business
day. Complicated claims or claims requiring quality review can take
an additional business day to reprice. These claims EXCLUDE those
being directly negotiated by CAI. For negotiations, the claims will
be returned within the time frames determined by you.
Q. Is CAI Willing To Guarantee Savings?
A. Yes. CAI continues to be a leading edge company, and has created a solution
to protect savings for its clients. We have developed client specific programs
to guarantee savings while also streamlining the administration of the repricing
process. We would be glad to discuss his in more detail.