Healthcare Networks
 Pinnacle provides
several options for selecting the type of health
care network that meets the needs of employees and
their families, including PPO, EPO and other networks. Pinnacle also has special
relationships with Anthem Blue Cross of California and providers in
Mexico.
PPO Networks
Pinnacle currently
has preferred provider relationships with
Anthem Blue Cross of California,
Blue Cross Blue Shield of Arizona,
Preferred Health Network (PHN),
Multiplan and
Interplan. PHN provides access to a nationwide
provider network. These contracts are based upon the
following:
- Reduced all
inclusive per diem rates for inpatient hospital
services
- Global and
discount off charges arrangements for outpatient
hospital services
- Professional
claims negotiated on a discounted fee for
service basis
Pinnacle clients
utilizing these networks currently save more than 47
percent on hospital services and 33 percent on
professional services. Several reports are available
which outline the savings amount on a per claim
basis by group or by each participant within the
client's group.
EPO Networks
Pinnacle also works with
EPO networks that require a Primary Care Provider
(PCP) designation. Our system handles these networks
on a capitation or discounted fee for service basis.
Patients that are assigned to each PCP can be sent
electronically to the provider on a weekly or
monthly basis. Pinnacle ID cards can also indicate a
PCP for each family member.
Other Networks
Pinnacle can work with
an infinite number of other health care networks.
Our claims processing system can coordinate multiple
networks for any one group, including PPO and
EPO networks. Pricing for preferred provider
claims are calculated automatically and
electronically through a system to system interface.
Anthem Blue
Cross of California
Pinnacle's current
arrangement with
Anthem Blue Cross of California takes place in a
paperless claims processing environment. Hospital
and professional claims are received electronically
from Anthem Blue Cross, re-priced using the appropriate fee
schedule, and automatically adjudicated in
Pinnacle's system against the participant's plan of
benefits.
Providers in Mexico
For more than 15 years,
Pinnacle has developed contractual relationships
with providers in Mexico including the border cities
of Mexicali, San Luis, Tijuana, Nogales, and Palaco.
The Mexican Panel Program provides employees with
access to health care in Mexico for a small
co-payment when utilizing network hospitals and
providers. In order to participate, providers adhere
to a strict Utilization Review procedure for
surgical and hospital services. Providers are
contracted with on a deeply discounted fee for
service and a maximum fee amount per month,
resulting in a 60 percent savings when compared
against U.S. prices for the same services.
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