winter 2015

Capsule

NEED TO KNOW NEWSPAGE 3

HEALTHLINK SPOTLIGHTPAGE 3

PRODUCTS AND SERVICESPAGE 2

ProviderInfoSource - Administrative Simplification for Health Plan Administrators ProviderInfoSource is a private, restricted portal utilized by providers to obtain real-time eligibility verification and online claim status which can alleviate costs associated with health plan administration. Contact your HealthLink representative for more information on getting set up on ProviderInfoSource.

Pre-Cert List Update Effective Jan. 1, 2016HealthLink has updated the list of procedures and services subject to medical necessity review for 2016. The additional service includes:

• Private Duty Nursing

For more information please contact PayorRelations@HealthLink.com.

Shopping for Stop-Loss CoverageHow self-funded employers can receive better rates for reinsurance coverage

As employers continue to search for alternative funding solutions to combat the high cost of health care, more companies now offer stop-loss or reinsurance coverage. This has created a unique environment for those shopping for stop-loss policies and may present an opportunity for employers and brokers to negotiate lower fixed rates for reinsurance coverage.

According to Mark Haegele, Regional Vice President of Sales at HealthLink, “Not all employers and brokers realize how much room for negotiation is available when shopping for stop-loss coverage.”

How can employers and brokers negotiate with stop-loss carriers?The main components of a self-funded model are the third-party administrator (TPA) that pays claims; pharmacy benefit manager (PBM), a network, such as HealthLink that contracts with doctors and hospitals for discounts; and the reinsurance carrier. However, it’s important to remember that in the eyes of the reinsurance carriers, there is no perfect model of self-funding components. This may open the door for the employer and broker to play a vital role in controlling the premium and overall stop-loss

cost. If you can validate the effectiveness of your vendor alignment – your TPA, network and PBM – you may be able to negotiate a decrease in premium.

In order to be successful at this, you must first demonstrate, in a refined and focused way, how you are working to manage and even lower the impact of large claims and why your specific arrangement warrants a discount.

How can you demonstrate your management of large claims?There are a number of strategies for controlling large claim costs. One example would be to add a dialysis or transplant carve out in your plan design. In this instance, you will pay a small premium for a transplant insurance policy and in-turn the reinsurance carrier gives you a credit.

Another option is working directly with your PBM. For a typical reinsurance carrier, more than 25% of all large claims are represented by prescription drugs. Finding a PBM that may be willing to further negotiate costs could reduce that expense and earn you a discount on your premium.

continued on page 3

Complete Your Benefits Package with Specialty ProductsOffering an entire spectrum of Specialty Products to fill in the gaps in an existing health plan is important for your employees. Together our affiliated companies cover more than 35 million people nationwide and deliver an outstanding comprehensive specialty portfolio. These Specialty Products are a great addition to a current HealthLink customer’s network program or as a standalone option for non-HealthLink clients:

DentalDental’s unique and comprehensive three network options offer employers choices not found in any other dental plan by offering three price points and distinctive, quality service from more than 500 dentists and specialists.

Life and DisabilityFeaturing a variety of options to choose from, outstanding claim service and a focus on returning employees to work, A Life and Disability program is the perfect way to complete an existing health plan. Additional features give members counseling and consultation services during times of need and offers support while traveling.

UniView VisionWith access to the largest national vision network that includes more than 44,000 independent provider and marquee retailer locations and the longest customer service

hours in the industry, UniView Vision members can

receive additional discounts over plan allowances from in-network providers after benefits are utilized.

Employee Assistance Program (EAP)Several plan designs to fit employer needs and budget with a robust EAP provider

network including access to a work-life resource network across the country.

To learn more about the complete Specialty Products portfolio, please contact HealthLink’s Sales Department at 800-235-0306.

Network arrangement adds more than 300 hospitals and 16,000 health care professionals to service area

HealthLink’s network arrangement with Midlands Choice, a regional preferred provider organization, enables employers to keep their health plans flexible and responsive to their employees’ needs by expanding HealthLink’s core service area to include Northern Illinois, Iowa, Nebraska, and South Dakota. Now employers with multi-sited locations, and members who need health care outside of the HealthLink service area, have the ability to better manage overall health care costs while also

providing members with a better health care experience. To learn more, please contact HealthLink’s Sales Department at 800-235-0306

HealthLink and Midlands Choice Expand Network Access for Clients

Iowa

South Dakota

Nebraska

Missouri

Illinois

Adair

Adair

Adams

Adams

Adams

Alexander

Allamakee

Andrew

Antelope

Appanoose

Arthur

Atchison

Audrain

Audubon

Aurora

Banner

Barry

Barton

Bates

Beadle

Bennett

Benton

Benton

Black Hawk

Blaine

Bollinger

Bon Homme

Bond

Boone

Boone

Boone

Boone

Box Butte

BoydBremer

Brookings

Brown

Brown

Brown

Brule

Buchanan

Buchanan

Buena Vista

Buffalo

Buffalo

Bureau

Burt

Butler

Butler

Butler

Butte

Caldwell

Calhoun

Calhoun

Callaway

Camden

Campbell

Cape Girardeau

Carroll

CarrollCarroll

Carter

Cass

Cass

Cass

Cass

Cedar

Cedar

Cedar

Cerro Gordo

Champaign

Chariton

Charles Mix

Chase

Cherokee

Cherry

Cheyenne

Chickasaw

Christian

Christian

Clark

Clark

Clark

Clarke

Clay

Clay

Clay

Clay

Clay

Clayton

Clinton

Clinton

Clinton

Codington

Cole

Coles

Colfax

Cook

Cooper

Corson

Crawford

Crawford

Crawford

Cumberland

Cuming

Custer

Custer

Dade

Dakota

Dallas

Dallas

Daviess

Davis

Davison

Dawes

Dawson

Day

De Witt

DeKalb

DeKalb

Decatur

Delaware

Dent

Des Moines

Deuel

Deuel

Dewey

Dickinson

Dixon

Dodge

Douglas

Douglas

Douglas

Douglas

DuPage

Dubuque

Dundy

Dunklin

Edgar

Edmunds

Edwards

Effingham

EmmetFall River

Faulk

Fayette

Fayette

Fillmore

Floyd

Ford

Franklin

Franklin

Franklin

Franklin

Fremont

Frontier Fulton

Gage

Gallatin

Garden

Garfield

Gasconade

Gentry

Gosper

Grant

Grant

Greeley

Greene

Greene

Greene

Gregory

Grundy

Grundy

Grundy

Guthrie

Haakon

Hall

Hamilton

Hamilton

Hamilton

Hamlin

Hancock

Hancock

Hand

Hanson

Hardin

Hardin

Harding

HarlanHarrison

Harrison

Hayes

Henderson

Henry

Henry

Henry

Hickory

Hitchcock Holt

Holt

Hooker

Howard

Howard

Howard

Howell

Hughes

Humboldt

Hutchinson

Hyde

Ida

Iowa

Iron

Iroquois

Jackson

Jackson

Jackson

Jackson

Jasper

Jasper

Jasper

JeffersonJefferson

Jefferson

Jefferson

Jerauld

Jersey

Jo Daviess

Johnson

Johnson

Johnson

Johnson

Jones

Jones

Kane

Kankakee

Kearney

Keith

Kendall

Keokuk

Keya Paha

Kimball

Kingsbury

Knox

Knox

Knox

Kossuth

LaSalle

Laclede

Lafayette

Lake

Lake

Lancaster

Lawrence

Lawrence

Lawrence

Lee

Lee

Lewis

Lincoln

Lincoln

Lincoln

Linn

Linn

Livingston

Livingston

Logan

Logan

Louisa

Loup

Lucas

Lyman

Lyon

Macon Macon

Macoupin

Madison

Madison

Madison

Madison Mahaska

Maries

Marion

Marion

Marion

Marshall

Marshall

Marshall

Mason

Massac

McCook

McDonald

McDonough

McHenry

McLean

McPherson

McPherson

Meade

Mellette

Menard

Mercer

Mercer

Merrick

Miller

Mills

Miner

Minnehaha

Mississippi

Mitchell

Moniteau

Monona

Monroe

Monroe

Monroe

Montgomery

Montgomery

Montgomery

Moody

Morgan

Morgan

Morrill

Moultrie

Muscatine

Nance

Nemaha

New Madrid

Newton

Nodaway

Nuckolls

O'Brien

Ogle

Oregon

Osage

Osceola

Otoe

Ozark

Page

Palo Alto

Pawnee

Pemiscot

Pennington

Peoria

Perkins

Perkins

Perry

Perry

Pettis

Phelps

Phelps

Piatt

Pierce

Pike

Pike

Platte

Platte

PlymouthPocahontas

Polk

Polk

Polk

Pope

Pottawattamie

Potter

Poweshiek

Pulaski

Pulaski

Putnam

Putnam

Ralls

Randolph

RandolphRay

Red Willow

Reynolds

Richardson

Richland

Ringgold

Ripley

Roberts

Rock

Rock Island

Sac

Saline

Saline

Saline

Sanborn

Sangamon

SarpySaunders

Schuyler

SchuylerScotland

Scott

Scott

Scott

Scotts Bluff

Seward

Shannon

ShannonShannon

Shelby

Shelby

Shelby

Sheridan

Sherman

Sioux

SiouxSioux

Spink

St. Charles

St. Clair

St. Clair

St. Francois

St. Louis CitySt. Louis County

Stanley

Stanton

Stark

Ste Genevieve

Stephenson

Stoddard

Stone

Story

Sullivan

Sully

Tama

Taney

Taylor

Tazewell

Texas

Thayer

Thomas

Thurston

Todd

Tripp Turner

Union

Union

Union

Valley

Van Buren

Vermilion

Vernon

Wabash

Walworth

Wapello

Warren

Warren

Warren

Washington

Washington

Washington

Washington

Wayne

Wayne

Wayne

Wayne

Webster

Webster

Webster

Wheeler

White

Whiteside

Will

Williamson

Winnebago

WinnebagoWinneshiek

Woodbury

Woodford

Worth

Worth

Wright

Wright

Yankton

York

Ziebach

SM

Midlands Choice Service Area

HealthLink Service Area

winter 2015

HealthLink associates rolled up their sleeves and volunteered their time for two events held during Volunteer Days, a company-wide month of service in October. At the first event, held on October 3rd, associates joined the local fire department at Fire Safety Day at the Delta Gamma Center for Children with Visual Impairments. Associates joined the children in a fire drill, exploration of the fire truck and ambulance and participated in obstacle courses. On October 16th, associates joined the local Lions Club to pack weekend food bags at the Rap and Pack event, a part of Operation Food Search, where a total of 1,800 bags of food were packed for 33 schools in 11 districts in under an hour.

This was the inaugural year for the annual Volunteer Days program. Each event was very successful and enjoyed by all in attendance.

As of October 1, 2015, HealthLink is LIVE with ICD-10 as the code set for medical diagnoses and inpatient hospital procedures in compliance with HIPAA requirements and in accordance with the rule issued by the U.S. Department of Health and Human Services (HHS).

How did HealthLink prepare for ICD 10?Associates worked hard to ensure there were no business distruptions by configuring all Electronic Data Interchange (EDI) outbound transmissions to payors (including insurance carriers, TPAs and self-insured employers) to accommodate ICD-10 codes.

HealthLink Associates Roll Up Their Sleeves During Company-Wide Month of Service

ICD-10 Now LiveBoth of these practices will not only help you reduce the cost of your stop-loss premium, but can also help you control your overall claims in the long run. HealthLink also has a variety of cost containment solutions and reporting capabilities that may help you better manage your claims.

How should employers and brokers examine stop-loss carriers to find the best price?The most important fact to keep in mind is that reinsurance carriers place a “rating” on networks and give them different levels of credibility with respect to their discounts. This means carriers determine their own version of your network’s discount by applying their creditability percentage to it.

The good news is selecting a stop-loss carrier that already has a good relationship with your network could lower your premium. HealthLink has worked hard to establish strong relationships with stop-loss carriers and ensure our network has a high creditability rating and our clients can receive the highest premium discounts available. Contact your HealthLink representative for a full list of stop-loss carriers and for more information about how you may be able to lower your premiums.

Shopping for Stop-Loss continued from page 1

Volunteers at Rap and Pack event.

Participating in Fire Safety Day.

HealthLink®, Inc., is an Illinois corporation. HealthLink, Inc. is an organizer of independently contracted provider networks, which it makes available by contract to a variety of payors of health benefits. HealthLink has no control or right of control over the professional, medical judgment of contracted providers, and is not liable for any acts or failures to act, by contracted providers. HealthLink, Inc. is not an insurance company and has no liability for benefits under benefit plans offered or administered by payors. HealthLink® is a registered trademark of HealthLink, Inc.

Our goal in creating Network News is to inform clients of pertinent information helpful to your business relationship with HealthLink. We welcome your ongoing feedback.

Editorial Board: Steve Martenet, HealthLink President; Brian Fallon, Director of Payor Relations, Business Development and Network Management; Tami Fenstermacher, Technical Writer, Payor Relations; Susan French, Director, Marketing/Communications; Alicia Pyatt, Marketing Communications Writer; Jeff Wulfert, Senior Designer. Comments or suggestions: (800) 624-2356.

1831 Chestnut StreetSt. Louis, MO 63103

Provider Updates PRSRT STD

US POSTAGEPAID

SAINT LOUIS, MOPERMIT NO. 1514

New PPO, Open Access (HMO) and Workers’ Compensation Contracts • Freeman Surgery Center of Pittsburg, LLC, Pittsburg, KS

(added to the Freeman Hospital agreement). Effective October 1, 2015.

• Frontenac Surgery and Spine Care Center, St. Louis, MO. Effective October 15, 2015.

• Marion Healthcare (ambulatory surgery center), Marion, IL. Effective October 1, 2015.

• SEPM Missouri Services, PC (ER group servicing multiple BJC facilities), St. Louis, MO. Effective November 15, 2015.

• SE Emergency Physicians of Memphis, PC (ER group servicing Boone Hospital), Columbia, MO. Effective November 15, 2015. FOLLOW US ON:

linkedin.com/company/healthlink-inc-