Market Gulf Coast to self-insured employer groups

• Bi-Monthly Manager Meetings
• Carrier Meetings
• PHO Web-site training
• Carrier policy updates

Once the PHO Credentialing Committee and Board approves an application, a notification goes to all the carriers/networks that you selected to participate with utilizing the member effective date on your welcome letter. The process of loading could take some time so, we suggest you hold all claims for at least 30 days apart from Aetna and Humana* that take between 60-90 day in loading. If claims are submitted and you have not been loaded into their system, the claim will be denied, and you will need to contact the carrier network or the PHO.

What is important for you to know, we are a Messenger model PHO, so the members vote on any new agreements presented to determine if 51% approve that it is a good agreement and then select if they want to participate per group. Contracts automatically renew each year. If there is an issue with a carrier, we share with the Board and advise the membership of any concerns and possibilities.

• Claims assistance
• Provider network issues
• Patient grievances
• Contract compliance

What can be accessed on the PHO secured web site?

• Fee schedules
• Carrier contracts
• Credentialing applications
• Corporation Maintenance (updates including addresses, phone numbers etc.)
• Physician Profile Updates (includes terminations)
• Maintain User Account (authorization personnel, billing personnel, credentialing companies etc.)