FAQs for Health Plans
Does CHP contract with health plans?
Yes! CHP does contract with health plans. We offer contracts with a variety of financial models including:
- Network Lease with Outlier Management (post-payment review)
- Administrative Services Only (ASO)
- Partially and Fully-Capitated arrangements
What geographic areas does CHP serve?
CHP is a regional network with a current concentration in Oregon. We are actively growing our provider network in the Pacific Northwest and Mountain West regions – principally, Oregon, Washington, Idaho, Utah, Colorado, Montana, and Alaska.
What kinds of benefit plans are available from CHP?
Instead of offering a limited set of plans, we work with each client to design a benefit plan that works for them. Whether their solution requires a fairly standard plan or one that is specially-designed, we have the experience and expertise to design custom plans to fit the needs of our health plan partners.
How does CHP credential its provider network?
We credential our provider network using NCQA guidelines. Additionally, we employ certain proprietary requirements that providers must fulfill to participate on our network. We require that providers meet these standards so that our customers can be confident entrusting their members’ care to our network.
Does CHP offer exclusive plans to specific health plans?
Yes! We are always happy to work with health plans to meet your specific needs. There may be a time when that requires exclusivity. We would be pleased to discuss this with you.
Does CHP require referrals for network services?
The use of a referral model is a decision that is made by the payor. We have had considerable success using a model that does not rely on referrals but rather engaged management of the network that allows member access without the obstacles that referrals represent.
Our preference is to manage our network in such a way as to produce outcomes that are predictable and that make the best clinical and therapeutic sense.
How does CHP manage our quality provider network?
We start with our credentialing model. We use NCQA guidelines to credential our network providers. In addition, we have our own proprietary requirements for network participation.
Our network providers must also agree to our “Philosophy of Care” statement. Once providers are on the network, we monitor them through random site visits, random claim reviews, clinical records review, and supporting documentation requests. We monitor claims experience to identify outlier behavior and manage the network to the norm. If a provider demonstrates outlier behavior, they are given an opportunity to either demonstrate the reasons for appearing outside the norm or to self-correct so that their practice patterns are more in line with their network peers.
Does CHP handle customer service for members and employers?
CHP will manage customer service to the specification of the health plan. We are a service-oriented organization. As our metrics illustrate, we provide excellent service. We provide customer service for members and employers primarily through telephonic communication with some electronic and fax communication when appropriate.
Is CHP HIPAA-compliant?
Yes. CHP is committed to protecting the confidentiality of all member information and records. Our organization is compliant with HIPAA regulations, using and disclosing protected health information (PHI) only when appropriate to protect member privacy and assure security of their information.