Services for Health Plans

Through a partnership with The CHP Group, health plans who are facing increasing pressures related to the cost of medical care – and consequently insurance premiums – can find integrative healthcare (IH) benefits that help to mitigate claims costs while promoting the health and wellness of the health plan population.

The CHP Group offers our streamlined services to seamlessly administer IH benefits. Our unique proprietary utilization management model ensures members receive treatment from highly qualified providers who promote care that is evidence-based, therapeutically-effective and cost-effective. Our payer partners can select from a variety of services including:

  • Network lease
  • Administrative services only (ASO)
  • Capitated arrangements
  • Wellness plans
  • Credentialing services
  • Affinity plans

Our complete integrative healthcare solution is one that gives our customers what they need in complementary and alternative medicine – a partner they can trust, a high-quality network of credentialed providers, satisfied members, and measurable cost savings. The components shown below can be combined to create a variety of scalable solutions. When all the components are implemented our customers achieve the greatest value. We pride ourselves on our ability to build and maintain mutually beneficial partnerships with our health plan customers and facilitate a variety of funding arrangements based on the goals our customers have for meeting their integrative healthcare needs – including administrative services only, shared savings, partially capitated or capitated arrangements.

Consulting

Take advantage of The CHP Group’s expertise in integrative healthcare (IH). We help our health plan customers develop complete IH solutions that provide your members access to high-quality, evidence-based health care. More importantly, our consultation spotlights network management and provider reimbursement strategies that ensure care is delivered in a therapeutically-rational and cost-conscious manner. Consulting services include:

  • Benefit plan design
  • Fee schedule
  • Integrative healthcare best practices
  • Clinical pathways
  • Fraud and abuse detection
  • Provider reimbursement strategies
  • Transition planning
  • Claims analysis

Network Strategy

Our integrative healthcare network approach effectively serves the needs of our health plan partners by addressing three specific areas: cost containment, patient satisfaction, and provider participation.

CHP is committed to partnering with only the highest-quality providers in each of the four disciplines represented in our network (chiropractic, naturopathic medicine, acupuncture and massage therapy). We are keenly aware of the number of providers necessary to serve a given population and, understand that too many providers in an area may actually compromise quality and drive unnecessary utilization. Let our experts help design your network to produce the best therapeutic and financial outcomes.

Claims Administration

CHP provides sophisticated administrative services for integrative healthcare (IH) claims in an accurate, prompt, and cost-effective manner. Leveraging our expertise in this segment, we have configured a claims system embedded with a series of unique rules and edits specific to IH services. Our proprietary claims systems produce unmatched results that include:

  • Identification of coding and claims submission errors
  • Eligibility Management
  • Detection of combinations of therapeutic services that may compromise the quality and efficacy of care
  • Analysis of medical necessity determination and plan benefit limitations
  • Determination of utilization trends that deviate from accepted norms
  • Detection of potential fraud and abuse

Medical Management

CHP is dedicated to continuous quality improvement in the management of our network to optimize the value of the programs and services that we provide to our health plan partners. We have built a multi-faceted Quality Management System designed to monitor many aspects of our network providers’ practices, including treatment patterns, administrative capabilities, clinical documentation, and patient safety. We make certain our requirements are clear, consistent and fair so our providers know what we expect.

Our Utilization Management program ultimately ensures the following expectations are consistently met:

  • Medically necessary services are delivered
  • Medically unnecessary services are constrained
  • Under-utilization of medically necessary services is avoided

Customer Care

Building and retaining strong relationships with our customers is the backbone of our company. When we are chosen to act as a health plan partner, we understand that your members have come to expect exemplary service. We treat our clients’ members the same way we treat our own – with care and professionalism. Our team of Customer Service Representatives is expertly trained in IH benefit plan design structures, Common Procedure Terminology (CPT®) codes and claims payment administration. This in-depth knowledge can prove invaluable to members and normally results in first call resolution to any issues. We maintain appropriate staffing levels to ensure accessibility for members during regular business hours. Other customer services we provide include:

  • Eligibility confirmation
  • Benefit plan explanation
  • Provider information
  • Claims and EOB
  • Reporting
  • Complaint resolution
  • Account Management

Integrative Healthcare Wellness Programs

Integrative healthcare (IH) is an exceptional fit within the wellness framework. CHP has developed the following IH wellness programs, which can be implemented as stand-alone benefits or added as components to a larger solution:

  • The CHP CAMaffinity Program encourages members to explore less invasive and less expensive treatment options by arranging discounts for CAM services through our network of elite providers.
  • The CHP Active and Healthy Program provides access to thousands of discounted opportunities designed to get members moving and having fun!
  • The CHP CAMplus Program combines the benefits of The CHP CAMaffinity Program and The CHP Active and Healthy Program.