Networks
This national network has an option that is often paired with RBP.
What is Anthem PAO?
These can include traditional & pass thru
What are PBM pricing structures?
Bondo provided an analogy of stop loss representing this fun toy from the 1980s
What is a Rubik's Cube?
This is the claim dollar threshold that places a member in the RBP Outreach Program.
What is $1,000?
This individual is responsible for the 'first pass' at any inbound information received from a broker or prospect - including census reviews and SPD/SBC reviews.
Who is the seller?
This WI network offers a payment platform & members have no up front costs for services.
What is HPS/PayMedix?
PBMs may encourage use of lower-cost alternatives to specialty biologics called these.
What are biosimilars?
This type of stop loss utilizes a specific deductible, paid by the employer, on all claimants that breach the specific deductible level.
What is Aggregating Specific?
These are an employer concern that make for great discussion about RBP with all group types (renewal & new sales)
What are OON (out-of-network) Claims?
This Anthem JAA product allows members to communicate via two-way, live video chat on their computer, smart phone or tablet.
What is LiveHealth Online?
This network offers PPO, PAO, and MEC plans without a minimum number of enrolled employees.
What is HealthSmart?
This non-carrier PBM offers both traditional and pass thru pricing models.
What is Prime Therapeutics (formerly MagellanRX)?
Stop loss vendors need at least this many months of current year data to provide a stop loss quote
What is 6 (months)?
This process uses timeline touchpoints once a member enters the program, including email reminders and concierge calls.
What is the balance billing resolution process?
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What is Time Magazine?
Some of these include notification in writing with an existing Anthem group and written permission where applicable.
What is Anthem's Quoting Requirement?
You can find Pharmacy Strategy, the PBM Message Map & PBM Partner Comparison here at this internal resource
What is the TPA PBM Hub (Seismic)?
DAILY DOUBLE!!!!
This solution solves client's cash flow disruptions
What is Personify Rapid Advance?
This is the average bill rate percentage for RBP
What is 2-5%?
There are more than 20 of these that can deliver savings to employers, with innovative solutions driving the highest levels of savings.
What are benefit levers?
This secondary network, owned by Aetna, offers MEC plans, Limited Benefit plans & an out of network wrap plan.
What is First Health?
This allows the sales team to use the future value of the rebates to offset TPA Administration costs
What is Rebate Reinvestment?
Stop Loss resources at our fingertips include the Stop Loss team, Seismic, Carrier Partner Websites & this free video database
What is YouTube?
This incentive encourages providers to accept RBP pricing during the prior authorization process.
What is a Single Case Agreement (SCA)?
HI Trust, PPEDA and NIST are all examples of Personify's efforts to approach this
What is Information Security?