Why ppoNEXT?

Because a true business colleague looks out for your interest
Since we are independent and not owned by any health plans or managed care organizations, we are able to take an objective and consultative approach to serving our clients. Through our consultative approach, we align our objectives with those of our clients by helping them reduce healthcare expenditures while increasing consumer health and satisfaction.

Because we are a long-term answer to your healthcare needs
Our financial strength coupled with our ethical and experienced leadership creates client-confidence in our organization's stability. As the managed care industry continues to consolidate, clients will find in us a stable, long-term partner that provides consistently high levels of service and value.

Because we help create informed consumers
Empowering participants to become more proficient and proactive in managing their health results in a more judicious use of health care resources. Our consumer focused programs such as Disease Management, and Nurse Advice Line "links" the entire health plan's staff and vendors, interacting with the plan sponsor's Claims, UM, Pharmacy, and Network administrators to identify patients at risk and to guide patients in using their healthcare benefits in the most appropriate and cost-effective manner.

Because making the transition is easier then you think
We understand switching vendors is typically viewed as an arduous task. From contracting through implementation, we simplify the process by keeping the sales team involved so that nothing is "lost" in the transition process. Implementation starts with a "Pre-Launch" meeting ensuring both parties understand all requirements and tasks. Through our project team's professionalism and expertise, we alleviate any anxiety or concerns upfront. Clients leave with a sense of confidence knowing that such detailed planning is being applied to their implementation.

Because it all starts with access
Bringing our clients the best in local and regional healthcare providers at discounted rates is what we do best. Our regional contracting experts use their local community knowledge of the healthcare environment to negotiate the most competitive rates available. We balance our aggressive contract negotiating with equal concern for quality of care. Our NCQA patterned credentialing program ensures access to the highest quality healthcare facilities and providers.

Because we deliver on our promises and will not be under sold
Our flexible and straightforward sales approach is built on integrity and trust. Our sales staff stays involved every step of the way - from the initial proposal, negotiations, contracting, and even implementation - ensuring nothing gets "lost" along the way. Because ppoNEXT guarantees to beat any competitor's pricing, clients are assured of obtaining the industry's best rates. In addition, we offer a 3-year fixed rate guarantee - helping our clients better control and anticipate their future administrative cost.

Because we understand the formula for service excellence
We hire top-notch professionals with the proper experience, knowledge, and attitude. We add in-depth training paving the way for their success. Then we give them the technology they need to perform their functions to the highest degree of accuracy and efficiency. The result is a skilled professional equipped with the tools and technology needed for delivering service excellence.

Because our people want to provide outstanding service
Outstanding customer service comes from people with the proper aptitude and attitude. Our client and member service personnel excel at what they do because they enjoy what they do. It's evident through our call tracking and client survey results, which consistently demonstrate our ability to provide outstanding service.

Because our medical management services provide even greater savings
The 30 years of experience from our medical management division - NEXT care management [formerly Health Care Evaluation (HCE)] results in average client savings of $7 for every $1 dollar spent. Our URAC accredited programs provide assurance to patients, providers, purchasers, and employers that our utilization services are fair and equitable for all parties. We strike the perfect balance between helping clients control costs and respecting the patient-doctor relationship.

Because we deliver efficient and responsive medical management services
Our clinical resources (175 clinicians/40 specialties) mean we consistently meet or beat performance objectives such as response and turnaround time. However, clients do not have to rely on ppoNEXT's word. We have validated results proving our ability to provide UM services at an outstanding value and at consistently high levels of performance. Some clients have been with us since the 80's - lending more proof to our medical management success.

Because we seize every opportunity to direct patients into the network
The savings associated with increased network use is well known and documented. We truly want to help our clients cut healthcare costs so we do all we can to direct patients into the network. Medical management, disease management, and nurse advice line staff proactively guide patients to network providers whenever appropriate. Our customer care call center is there to help patients locate network providers and our online directory and provider lookup tool is one of the few systems that return plan-specific results. Finally, our provider contracts require providers to refer to other network providers whenever appropriate.

Because using the latest claim repricing technology saves money and time
Electronic claim repricing results in reduced costs and increased operational efficiencies. Repricing using WebCR means client only need Internet access. There is no need for additional hardware, software, or networking. Additional savings also comes from having access to the most current repricing data. By eliminating manual intervention, turnaround times and error rates are greatly reduced. With Internet repricing, accuracy increases while cost decreases - a powerful combination.

Because we provide meaningful data and reports for informed decision making
ppoNEXT's data warehouse will be a single repository of business data that is current and accurate. Through a web-based portal, clients will have on-demand access to predefined and ad hoc reports. Through our standard report suite, we also offer over 300 reports allowing clients to customize the reporting package that works best for their decision support needs.