Health EZ/America`s PPO

5/18/16
Founded in 1982 by Nazie Eftekhari
The original Preferred Provider Organization
What’s New for 2016
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Continued Huge Growth!
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HealthEZ – 40% Growth
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America’s PPO - continues to be the primary network for
Mayo Clinic Health Solutions for MN and WI
Over 350,000 members through HealthEZ, national networks,
insurance carriers and TPAs
Cost Plus Model - Health Reform
•  HealthEZ administers partially self-funded plans – we are not an insurance company
nor do we have any government business
•  Most of ACA has been implemented; biggest change was definition of small group –
delayed until late last year causing much chaos in the 50-100 market
•  Employer Reporting causing many headaches
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5/18/16
Self-Funding in Health Reform
MEC Plans Minimum Essential Coverage Only
HealthEZ ID cards state this on the front – Preventive Coverage Only
for providers
✤ 
✤ 
✤ 
A HealthEZ member presents a
HealthEZ ID card with the statement: No Payment Due at the Time of Service
HealthEZ collects from the patient
what they owe you
You receive payment in full from
HealthEZ, patient and plan funds,
in one check
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with
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5/18/16
Illness
Complex Care
Management
Health
Chronic
Condition
Management
Advising
Step One
Foods
Preventive
Care
Facilitation
Challenges
Seminars
Activity Bands
EZfit
Vaccinations
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Seminars
Advising
Step One
Foods
Vaccinations
Activity
Bands
EZfit
Challenges
Boost Your
Baby
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Comprehensive Health
History
Biometrics
Claims
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5/18/16
Primary Care Models
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Primary Care Clinics
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Retrace Health
✤ 
Healthiest You
Other Models
Multiple benefit and network models in key national markets,
including: ✤ 
✤ 
Best-in-class plan design, carving out and dedicating key
services to top performing providers. ACO-based plans, with moveable walls to allow for
geographic and service flexibility. Credentialing Process
Criteria includes:
• 
Current valid license to practice • 
Background of education and training
• 
Board certification
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Work history
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Current malpractice insurance • 
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We accept MN/SD/IA credentialing applications, universal credentialing application, as
well as APPO custom application All providers must be approved by the APPO credential committee 4
5/18/16
Delegated Credentialing
Good for providers, good for payers:
• 
Reduces turnaround for network participation
• 
Quicker reimbursement from payers
• 
Increases practitioner and patient satisfaction
Interested in becoming a provider in our delegated network?
• 
Please see Chris Auger after the presentation
Member Education
✤ 
HealthEZ – access benefits, eligibility and claim status online
24/7
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Call Customer Service at 877-516-6687
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America’s PPO – 800-948-9451
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If claims received, can call Customer Service with questions
Provider Services team is ready to assist with any other questions or issues and will work with provider and
payer to get issues resolved as quickly as possible
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All providers must be approved by the APPO credential committee Organizational Structure
Executives
Provider Services
Finance
Amir Eftekhari
President
Chris Auger
Director, PPO
Josh Kutzler
CFO
Ben Weidman
Executive Vice President
Patrick Greenberg
Provider Services Analyst
Kate Nelson
Accounts Receivable Clerk
Jean LaFavor
Vice President, Sales
Jaleesa Wright
Provider Support Specialist
Emily Spear
Staff Accountant
Eric Lamote
Vice President, Risk
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