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PayFuseNet Capabilities

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PayFuseNet is a proprietary provider network of PayerFusion. With providers located all over the world, members of the PayFuseNet are granted access the best available healthcare no matter where they …

PayFuseNet is a proprietary provider network of PayerFusion. With providers located all over the world, members of the PayFuseNet are granted access the best available healthcare no matter where they are. Learn more about how you can benefit from PayFuseNet whether you're a provider, payer, or patient.

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  • 1. 5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739www.payerfusenet.com 1
  • 2. 5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739www.payerfusenet.com 2 OVERVIEW PayFuseNet gives your members freedom of choice while maximizing your savings through our cost-plus methodology. • Network presence established across the USA, Puerto Rico, the Caribbean, Latin America, Europe, Asia, New Zealand and South Africa. • Directly contracted and managed to ensure strong provider relationships and attain the most value for our clients. • Fully compliant with all USA federal and state regulations. • Zero-balance billing guarantee, worry-free access to care.
  • 3. 5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739www.payerfusenet.com 3 OVERVIEW A provider network is only as strong the connections between all parties in the healthcare equation. Advocacy on behalf of patients and plan sponsors to address care needs and maximize opportunities for cost savings. We can coordinate care in advance and work with all parties to manage claims already incurred or in process. Expertise attained through over 75 years of combined experience on all sides of the healthcare business means there’s never a situation we can’t handle. Compliance - Each claim that we adjudicate is validated relative to regulatory and compliance guidelines to ensure viability of payment based on the requirements of federal and state guidelines.
  • 4. 5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739www.payerfusenet.com 4 PROVIDER NETWORK OPTIONS
  • 5. 5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739www.payerfusenet.com 5 THE NETWORK WITHOUT WALLS With PayFuseNet, there is no such thing as an “out-of-network” provider. • Providers are contracted on a “cost-plus” basis with a competitive fee schedule that is fair to all parties. • Our cost-plus reimbursement methodology utilizes real cost & quality data to determine a fair retail price for medical services. This approach leads to fair and sustainable pricing for plan sponsors and their members.
  • 6. 5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739www.payerfusenet.com 6 THE NETWORK WITHOUT WALLS Our approach is the key to your savings, not provider membership and discounts on inflated charges. • When a member visits a provider that has not been contracted, we will invite the provider to join our network • With those not ready to join the network, we will settle the claim on a cost-plus basis and offer immediate payment as an incentive to reduce the billed charges down to cost-plus pricing.
  • 7. 5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739www.payerfusenet.com 7 COST-PLUS REIMBURSEMENT Cost-Plus reimbursement creates significant savings for plan sponsors while allowing providers a fair profit based on the actual cost of service. • Each claim is compared to national data reported by state and federal agencies, as well as to our own proprietary database • Utilizing this data, we determine the actual cost of service, needs of the provider to offset losses from providing under-funded care and the fair retail cost of the service provided. • Our expertise and experience on all sides of the healthcare industry gives us an invaluable advantage in negotiating effectively and maintaining long-term relationships.
  • 8. 5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739www.payerfusenet.com 8 COST-PLUS REIMBURSEMENT Rather than pursuing discounts on continually inflating prices, we leverage real cost and quality data, mined with our own unique algorithm to achieve superior and fair pricing.
  • 9. 5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739www.payerfusenet.com 9 PAYFUSENET VERSUS PPO PPO networks simply do not address the realities of today’s policies and the new challenges of the healthcare landscape. • PPO’s were designed for policies that are PPO in nature which carry differentials and incentives for in & out of network access. • These networks are now being used as a desperate means to achieve discounts on highly inflated retail prices. PPO networks are not concerned with the true cost of healthcare services. • With PPO networks becoming so extensive, the concept of “discount for volume” is nonexistent. Without this leverage, PPO networks cannot effectively control billed charges and chase discounts on inflated prices that continue to increase.
  • 10. 5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739www.payerfusenet.com 10 KEY ADVANTAGES PayFuseNet is designed to meet challenges and changes of today’s healthcare environment. • Specifically developed for self-funded employers and international insurers seeking the freedom of an open access plan without the premium price. • Our approach removes all network barriers because the reductions achieved are not contingent upon provider network membership.
  • 11. 5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739www.payerfusenet.com 11 KEY ADVANTAGES PayFuseNet focuses on the needs of all parties in the healthcare equation- payer, patient & provider! • Our cost-plus reimbursement methodology combined with innovative claims administration strategies results in the fair and stable pricing of healthcare services. • We provide plan sponsors and members with the highest level of customer service to ensure a hassle-free and positive experience
  • 12. 5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739www.payerfusenet.com 12