Novant Health | Physician Services | Managed Care Contracting

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Managed Care Contracting

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Managed Care Contracting

Healthcare providers that are members of ChoiceHealth will have immediate access to a wide range of managed care options. ChoiceHealth serves as an intermediary between providers and managed care payers. We currently have relationships with 13 payers and 17 plans.

The ChoiceHealth managed care target market is the small and medium payers in the marketplace. These payers wish to use large provider networks to efficiently grow and maintain their provider membership. ChoiceHealth uses the managed care contracting expertise of the Novant Health Business Development and Sales staff. We are responsible for contract language review and contract language negotiation. All network contracts are reviewed and edited by experienced healthcare attorneys.

Contract reimbursement is based upon fee-for-service rates using a "messenger model" process. This gives our members maximum flexibility to meet individual practice needs. ChoiceHealth does not sponsor risk/capitated contracts. Members have an "opt in" or "opt out" option on all contracts. Reimbursement ranges from 100% to 180% of Medicare (contracts are based upon 1999, 2004, 2006 or current year Medicare Fee Schedules), 96% to 98% of the NC Industrial Fee Schedule, or 50% to 95% of your billed charges.

In addition to network managed care contracts, ChoiceHealth also offers general consultation with "non-network" managed care companies.

Managed Care Contracts available through ChoiceHealth:

Managed Care Contracts	Product Type	Charlotte Area	Winston-Salem Area
Aetna Health, Inc**	ALL	Yes	Yes
CompCare Network (key Risk Management Services)	WC	Yes	Yes
First Health (includes former CCN contract)	PPO	Yes	Yes
First Health (includes former CCN contract)	WC	Yes	Yes
Great West (formerly One Health Plan)	POS	Yes	Yes
Great West (formerly One Health Plan)	PPO	Yes	Yes
HUMANA d.b.a. ChoiceCare Network	PPO	Yes	Yes
Kanawha Benefit Solutions, Inc.	PPO	Yes	N/A
MultiPlan, Inc.	PPO	Yes	Yes
Premier Health Systems	PPO	Yes	Yes
Primary Physician Care	PPO	Yes	Yes
Private Healthcare Systems, Inc.	POS	Yes	Yes
Private Healthcare Systems, Inc.	PPO	Yes	Yes
Provider Select	PPO	Yes	Yes
USA Managed Care Organization Genesis (Behavioral Health PPO)***	PPO	Yes	Yes
USA Managed Care Organization H&W Network (Group Health & Wellness PPO)***	PPO	Yes	Yes
Well Path Select, Inc	ALL	Yes	Yes

Pending Managed Care Contracts	Product Type	Charlotte Area	Winston-Salem Area
CAPE	P	N	N
FOCUS	P	P	P

KEY
- ** Not available to Chiropractors
- ***Chiropractic, Vision, & Mental Health may be carved out by some payor's
- ALL=Carrier has multiple product lines and provders cannot opt-out by product
- WC=Workers Compensation
- PPO=Preferred Provider Organization
- POS=Point of Service
- P= Pending
- N=Currently Under Negotiation
- N/A=Not Applicable
- Yes=Existing Contract

For More Information

Contact one of these ChoiceHealth offices for details:

ChoiceHealth
1900 Randolph Rd.,Suite 610
Charlotte, NC 28207
704-384-4975

ChoiceHealth
2085 Frontis Plaza Blvd.
Winston-Salem, NC 27103
336-277-1144 or 336-277-1461


	Other Information You May Be Interested In: Managed Care Plans Find a list of the managed care plans accepted by Novant Health. Aetna Visit the Aetna web site for plan and coverage information. First Health Visit the First Health web site for plan and coverage information. Great-West Life Visit the Great-West Life web site for plan and coverage information. Humana Visit the Humana web site for plan and coverage information. Kanawha Visit the Kanawha web site for plan and coverage information. Multiplan Visit the Multiplan web site for plan and coverage information. Primary Physician Care Visit the Primary Physician Care web site for plan and coverage information. Private Healthcare Systems Visit the PHCS web site for plan and coverage information. USA Managed Care Organization (USA MCO) Visit the USA Managed Care Organization web site for plan and coverage information. WellPath Community Health Plans Visit the WellPath web site for plan and coverage information. Premier Health Visit the Premier Health web site for plan and coverage information. Provider Select Visit the Provider Select web site for plan and coverage information.

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