Devon Health Expands Workers' Compensation/Injury Management Network
Devon Health is expanding its comprehensive network of healthcare providers for individuals who are injured on the job or in automobile accidents. We invite your practice to participate in this new opportunity to help people get back to work quickly and with positive outcomes.
The Devon Health Injury Management Program contracts with insurance companies, Third Party Administrators, self-insured employers, and case management and bill review companies to manage injury-related costs. Our Injury Management Program is focused on patient care and management while at the same time recognizing the needs of the providers.
Benefits of Joining our Injury Management Network:
- Increased Patient Base Through Network Participation
- Exposure to Large Insurance Companies, Case Managers and Claim Adjusters
- Competitive Reimbursement Rates
- Payment Resolution With Dedicated Provider Relations Staff
For more information on how you can join Devon Health’s Injury Management Program, please contact Josh Bean at jbean@devonhealth.com or at 800.431.CARE ext. 4952.
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Devon Health Welcomes New Team Member
Devon Health’s Network Management team is proud to introduce Daniel Meares as the new manager of hospital contracts and relations. In this position, Dan will play a large role in the development of Devon Health’s Preferred Network, the Secondary/Travel Network, and the Injury Management hospital network.
Dan may be familiar to some of you from his first role here at Devon Health four years ago as a provider relations representative when he worked closely with many key provider groups. Most recently, Dan gained valuable experience on the hospital side of the industry when he worked in an administrative capacity with executives on special projects at the St. Luke’s Health System in Bethlehem, PA.
Dan recently earned a Masters Degree in Health Administration (MHA) from the University of Scranton where he also received his B.S. in Business Administration and a minor in Health Administration. Dan also serves as a member of the American College of Health Care Executives. To contact Dan, please call 800.431.CARE ext. 4115 or email dmeares@devonhealth.com.
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Latest Addition to the Devon Health Portfolio: Secondary/Travel Network
In response to ever-changing and evolving market conditions, Devon Health is introducing a secondary/travel network to address the growing number of clients whose members are seeking an alternative to traditional larger health insurers. The secondary network is an unlogoed product.
Note: This alternative option has the potential to help your practice in several ways. How?
Increased Out-of-Network Payment: Patients who present for care but are out-of-network cause undue hardships for providers with increasing accounts receivables. Our secondary network can make you less vulnerable to out-of-network reductions, lowering risk for your practice.
Higher Reimbursements: More and more employers and individuals are seeking alternatives to the large dominant insurers, who often reimburse providers at a much lower rate. By joining the Devon Health Secondary Network, you will have an opportunity to enhance revenue since you will be paid at the existing Devon Health rate which is established in your provider services agreement.
Although patients will present with an ID card absent of the Devon Health logo, the explanation of benefits will cite the discount (s) taken in accordance with your provider services agreement. Also, being part of a Devon Health network assures advocacy for either real and/or disputed claims issues, and ensures prompt payment at network negotiated rates. A client roster will also be provided to you on a periodic basis, identifying the clients who would have access to your practice.
Participation in the Secondary Network is strictly voluntary and the decision is up to you.
If you would like more information on how you can become a provider in our Secondary Network, please contact Josh Bean at jbean@devonhealth.com or at 800.431.CARE ext. 4952.
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Provider Orientation Process Goes Virtual
Getting your practice acclimated to procedures and process for participation in Devon Health various networks just got easier.
Our Network Management Representatives are now available to perform an online orientation/in-service presentation for new and existing Devon Health network providers. The program focuses on helping providers understand the ins and outs of their participation in our network, what to look for when servicing Devon Health members, and proper claims submission procedures. This is an ideal program for office staff, billing personnel and administrators.
To register for an online orientation session, please visit fill out our online request form or contact Nick Leh, AVP of provider relations, at nleh@devonhealth.com or 800.431.CARE ext. 4133.
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Devon Health Forging Ahead with NCQA Credentialing Standards
Devon Health has incorporated the credentialing guidelines and standards of NCQA into its credentialing and re-credentialing process. In order to meet NCQA standards, we will be transitioning all groups that currently have delegated agreements under the former "PPO" non-NCQA process to either individual credentialing or sub delegated credentialing. Please note that the changes in the credentialing standards will not affect your current contract rather the means by which you are credentialed or re-credentialed into the network.
Physician groups will have the option to either individually credential each of the providers in the group or sign a sub delegation agreement if you are able to meet the requirements. In order to meet the sub delegation requirements the practice must be able to meet the NCQA criteria established.
You will be receiving a letter outlining the credentialing options that are available to your group. This information will allow you to determine which option is best for you, based on requirements for participation.
If you have any questions or concerns, please contact Devon Health’s Provider Relations department at 866-498-4773 or email Nick Leh, AVP of provider relations, at nleh@devonhealth.com.
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Fee Schedule Update
Devon Health uses a combination of Medicare RBRVS and other PPO pricing models to develop and maintain our proprietary fee schedules.
As per contractual terms, Devon Health reserves the right to periodically adjust fees in accordance with industry standards and market conditions. Updates typically occur only during the second quarter of each year, though it can be more often, but always with advance notice to our providers.
Recent Change: Last year saw the introduction of “site of service” provisions for the purpose of appropriately re-pricing in accordance with the physical location of where services are rendered. This culminated in the elimination of “IC”, or open ended codes, in favor of replacing them with actual fees.
Future Updates: Changes being considered for 2011 include the implementation of modifiers and CCI edits. As always, you will be notified ahead of time if these changes do occur.
For more information on fee schedules and how they impact your practice, please call the Provider Relations Hotline at 866-498-4773.
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New Devon Preferred Network Offers Winning Scenario for Providers
The healthcare landscape in Pennsylvania is fiercely competitive for both providers and payers. Devon Health, in efforts to bring additional value to participating providers while also attempting to create a more level playing field amongst payers, is in the midst of creating a new product.
Our “Devon Preferred” network will target best-in-class providers in terms of quality, outcome measures, and cost. We will market this network only top tier clients and payers in terms of financial standing, benefit plan designs, marketing capabilities/strategies and claims payment efficiency.
The goal is to aggressively compete for local business and to create a winning scenario for all stakeholders - providers, payers and consumers. Because the Pennsylvania market is so heavily dominated by only a few payers, any business clients Devon Health can win from one of those payers will result in an incremental gain to a participating provider’s bottom line. Access to Devon Preferred will be granted only for that incremental business. Additionally, Devon Health’s clients will be required to implement strong financial incentives in order to steer patients to participating Devon Preferred providers.
In return for this incremental volume and steerage, Devon Health is seeking market competitive contractual terms. Because our clients carry less overhead and maintain greater administrative efficiencies than dominant market payers, more competitive contracts will create the ability for Devon Health clients to price and market this product more aggressively.
Devon Health is optimistic about this initiative and has already received encouraging feedback from both providers and payers. For more information on becoming a Devon Preferred provider, please contact William Bruce, VP of hospital contracts, at 800.431.CARE ext. 4114 or wbruce@devonhealth.com.
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