The primary CoreChoice model is that of a specialty network/PPO to reprice radiology and interventional pain management claims in the workers’ compensation sector.
Our network is extensive and nationwide. We continue to contract medical providers on a daily basis and we believe that our network facilities provide excellent care to the patients that flow through our network.
CoreChoice has developed an additional model, the Exclusive Provider Organization (EPO) model.
In this model, we work with our clients to develop a specific network within a given city/state/region to service a carrier or employer group for the purpose of providing direct access care and at a very competitive price. In most cases, it is well below the contract rate that the provider has on their direct CoreChoice contract. In return for accepting this lower rate, the provider receives all of the referrals from that payer (carrier, employer group, etc) and that is very attractive to the provider.
How does the Exclusive Provider Network work for workers’ compensation?
The workers’ compensation sector EPO functions on a specific fee per exam basis. CoreChoice will provide the payer with the EPO group that will be used and will give the case manager or the adjuster direct access to the radiology facility for the purpose of scheduling an exam. CoreChoice can also provide a full scheduling service, as well as report retrieval.
The radiology facility is aware of the EPO client and will schedule the exam within 24 hours. Once the exam is complete, the radiologist’s report will be sent to the referring doctor, the case manager, and CoreChoice within 36-48 hours.
The radiology facility will send its bills to CoreChoice each month, and CoreChoice will submit them to the payer. Upon receipt of the payments from the payer, CoreChoice will then pay the facility its agreed EPO rate.
CoreChoice will monitor the entire process for each claim and provide a monthly utilization statement to our client.
EPO Model Brings Benefits to Payers and Medical Providers
- CoreChoice has the ability to handle prospective and retrospective claims nationwide and prospective scheduling.
- CoreChoice’s EPO saves the payers money, which is passed along to members.
- An EPO model makes sense for a health care provider, even at substantially discounted fees, because it increases their patient load and they know that they are going to get paid on a timely basis.
- An EPO model produces revenue for the provider network and its clients.
- CoreChoice can tailor or structure an agreement to fit your needs.