Welcome to Integra Health…the future of your practice begins today!
The Integra Healthcare network was created to serve the needs of individual O & P and DME practitioners. As a network member, you receive broad access to a valuable suite of resources to make managing your practice both rewarding and fulfilling—professionally and monetarily.
To answer our questions about Integra Health and to underscore the benefits of joining, please review the series of most frequently asked questions about Integra Health network membership presented below. You’ll be glad you took the time to learn how Integra Health is simplifying the business of healthcare.
What are the benefits of joining Integra Health?
What services and benefits do Integra Health members receive?
What contracts does Integra Health have?
What preferred vendors does Integra Health have?
What is the cost of membership?
What are the ongoing costs of membership?
Who is eligible to join Integra Health?
Will every applicant be invited to join?
What credentials does Integra Health require for acceptance
On what basis are contract acceptance decisions made?
Must I participate with every contract accepted by the network?
How does Integra Health determine reimbursement?
What can I expect to receive payment?
What is the withhold cap?
How quickly will I receive payments?
How does Integra Health place referrals?
Who is responsible for obtaining authorization?
How does the billing process work?
What are the requirements for quality training?
Q: What are the benefits of joining Integra Health?
A: As an independent provider, you must know what it means to be the small fish in a big pond. You also know that most major insurance systems are better suited to serve larger providers and are less so for smaller independents.
The Integra Health network levels the playing field. As part of a broad-based network of O & P and DME providers, Integra Health network members have the benefit of direct access to key insurers while eliminating the frustration and loss of productivity associated with reimbursement paperwork.
Integra Health also works to bolster your cash flow by negotiating directly with insurers to secure the best possible fee for services and to expedite reimbursements. Above all, Integra Health network members benefit immensely from their direct association with a large, more effective, and well-credentialed provider group.
Q: What services and benefits do Integra Health members receive?
A: Foremost is the access to Integra Health’s existing insurance contracts Integra Health network members receive. As a member, you will also have access to a significantly wider pool of referral patients. Our members enjoy the benefits of preferred vendor agreements, assistance with coding and billing, access to the Integra Health buyers group for better pricing on equipment and materials, reduced cost insurance premiums, bookkeeping, marketing assistance, IT, and business analysis consulting,
Q: What contracts does Integra Health have?
A: Integra Health maintains contracts with all major insurers and is in the position to establish contracts with any insurer essential to the success of your practice.
Q: What preferred vendors does Integra Health have?
A: Using the leverage of its provider network, Integra Health can assure access to preferred vendors that bring value to our individual network members.
Q: What is the cost of membership?
A: Integra Health membership is committed to a multi-tiered system based on the size of an individual practice. These tiers are:
Membership can be made to encompass subsidiary divisions that operate under a separate corporate name and tax ID number by applying for affiliate membership. Affiliate membership requires an additional fee of $50 per month, per affiliate. A separate application must be submitted and a separate Integra Health Subcontractor Agreement signed for each distinct affiliate.
Q: What are the ongoing costs of membership?
A: Managed care contracts administered by Integra Healthcare are partially funded by Integra Health membership dues and by withholds from insurer payment schedules. Members are billed for dues each month; membership may be cancelled if due payment lapses for more than 90 days.
Q: Who is eligible to join Integra Health?
A: Any independent ABC-accredited and/or state-licensed (where applicable) O & P and DME provider is eligible to join Integra Health.
Q: Will every applicant be invited to join?
A: The Integra Health membership committee reviews each application and bases acceptance on a several criteria including accreditation and membership saturation within a particular geographic location. Applicants will receive notification of a decision within 30 days of receiving an application. Integra Network reserves the right to accept applicants but defer membership based on “rate-of-growth” considerations in accordance with the measured growth strategy Integra Health maintains for the benefit of its current membership.
Q: What credentials does Integra Health require for acceptance?
A: At this point, Integra Health views the ABC Facility Accreditation as a requirement for membership and/or state-licensure (where applicable).
Q: On what basis are contract acceptance decisions made?
A: Contract acceptance decisions will depend on whether the insurer seeks commitments to service and credential an individual provider, or whether the insurer seeks instead to contract directly with Integra Health, thereby recognizing all Integra Health network members as participating subcontractors. In the case where the commitment is desired from an individual facility, Integra Health applies its “liaison modality” and all associated acceptance policies. Where an insurer is committed to including all Integra Health network members as subcontractors, Integra Health will base contract acceptance decisions on a case-by-case basis in accordance with precedent.
Q: Must I participate with every contract accepted by the network?
A: In those cases where the “liaison modality” has been applied and you have accepted the contract, you are required to participate, as per Integra Health network policy. In the case of contracts to which Integra Health commits, you are free to accept or reject referrals as you deem fit.
Q: How does Integra Health determine reimbursement?
A: Integra Health determines reimbursement in accordance with set policies as applicable to either “liaison modality” or subcontractor contracts.
Q: What can I expect to receive payment?
A: For “liaison modality” contracts, providers receive payment less an 8% wthhold. Integra Health network subcontractor contracts are offered a referral and reimbursement threshold, which you are free to accept or reject.
Q: What is the withhold cap?
A: Integra Health caps its withhold at 8%, ot to exceed $500. This payment model is subject to change, in the event of which, all Integra Health network members will receive proper notification.
Q: How quickly will I receive payments?
A: Members can expect to receive payment for service within seven (7) days of our receipt of payment.
Q: How does Integra Health place referrals?
A: For “liaison modality” contracts, referrals are arranged directly with the selected individual provider. Integra Health members entering into “liaison modality” contracts are free to request Integra Health handle authorization and billing. Subcontract contacts are placed on a rotating basis; only Integra Health network members are eligible to receive these contract referrals, unless refused by all Integra Health network members.
Q: Who is responsible for obtaining authorization?
A: From prescription to payment, Integra Health expedites the entire process. While Integra Health members may independently obtain authorization, they must be responsible for managing reimbursement for that specific submission.
Q: How does the billing process work?
A: Integra Health initiates referrals, obtains authorization, and submits the reimbursement request upon notification of a completed service.
Q: What are the requirements for quality training?
A: Integra Health members are provided with specialized quality training programs organized and given by Integra Health.
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