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Client Access Requirements

In order to ensure PHCS Savility acts as a single payer network, access to the network is restricted to insurer/administrator clients that agree to specific administrative and operational requirements. The most critical of these are summarized below.

Plan Design Requirements:

  • PHCS Savility members will be given an ID card that follows a standard format; the PHCS Savility logo will be the primary brand on the front of the card.
  • PHCS Savility will be the preferred (i.e., “quote first”) primary PPO network utilized with qualifying benefit plans on all new and renewal business within PHCS Savility markets. 
  • PHCS Savility will not be used with discount card, indemnity or plans falling below certain annual and per diem allowances.
  • PHCS Savility will not be offered to any benefit plans that have less than a 20% in-network/out-of-network differential.
  • Any utilization management program used will be URAC-accredited.

Claim Submission, Processing and Payment Requirements:

  • Provide daily add/change/delete and monthly full refresh eligibility files for active and recently terminated PHCS Savility members.
  • Receive all repriced claims directly from MultiPlan in a daily EDI file.
  • Adjudicate, process or deny 90% of clean, electronically-submitted claims within timeframes that support payment to the provider within 10 calendar days for UB and 15 calendar days for HCFA claims; adjudicate, process or deny 95% of these claims within 15 calendar days.
  • Initiate remittance via EFT to MultiPlan in full each business day for all claims submitted in the daily EDI file as ready to pay.
  • Enter into a cure period if remittance turnaround times are consistently missed, leading to potential disenrollment from PHCS Savility after two consecutive quarters of non-compliance.
  • Process 95% of all agreed-upon claim adjustments within 5 business days from the date of resolution. 
  • Abide by a 98.5% claims payment accuracy standard, based on the number of claims processed. 

Member and Provider Service:

  • Delegate provider service, and member service as it pertains to provider referrals, to MultiPlan for PHCS Savility issues.
  • Assign a dedicated team of customer service representatives who will work with MultiPlan to research and resolve provider issues.
  • Enable "hot transfers" for the purpose of responding to provider questions such as benefit determination and medical necessity, which require input from the insurer/administrator.
  • Communicate resolution plan for customer service issues within 2 business days for 95% of PHCS Savility-related issues.