(October 21, 2019) Boca Raton, Florida – CoreChoice, Inc. has developed and already implemented an additional medical cost containment model, the Exclusive Provider Organization (EPO), for the workers’ compensation sector. The current prospective network models used in the industry are failing, they are not user friendly, state fee schedules have markedly changed, and the overhead to support these models is prohibitive.
In the EPO model, CoreChoice will work with clients to develop a specific network within a given city, state, or region to service an insurance carrier or employer group for the purpose of providing direct access care at a very competitive price. In return for accepting this lower rate, the medical provider receives all of the referrals from that payer (insurance carrier, employer group, etc.). The CoreChoice network of medical providers is extensive and nationwide, and quality providers continue to be added on a daily basis.
“While the primary CoreChoice model is that of a specialty network/PPO to reprice radiology and interventional pain management claims in the workers’ compensation sector, we saw an opportunity to develop a specific network for our clients and others focused on competitive medical pricing, an innovative referral process, and dedicated client support groups,” stated Dr. Steven Gass, CEO of CoreChoice.
The CoreChoice EPO model provides for a direct referral for each patient, patient tracking, and will provide reports within 24-48 hours of the exam. The pricing for the EPO services represent a further significant discount as compared to the PPO rates. The case manager or the adjuster can also have direct access to the facility and CoreChoice will monitor the entire process for each claim. CoreChoice will provide monthly utilization statements to our clients as well as reports to our network radiology facilities. We have the flexibility to work with each client and, if necessary, develop multiple models to service their needs.
CoreChoice continues to use its PPO repricing system to wraparound the prospective network and provides nationwide coverage to over 5,000 radiology facilities. We have also developed a model to service states like California where the MPN process is in place and the fee schedule does not support the EPO model.
CoreChoice, Inc. is the only specialty network for radiology and interventional pain management whose mission is to reduce unnecessary health care costs through a variety of functions of health insurance, delivery of care, and administration, including our noteworthy specialty network Exclusive Provider Organization (EPO) program that is customized for each client’s needs. CoreChoice services the commercial group health, workers’ compensation, and auto liability insurance sectors. Our clients include cost management companies, PPO network groups, third party administrators (TPA), self-insured entities, employer groups, and government organizations. More information is available at www.corechoice.net or by calling 561-756-9110.