Premier Healthcare Exchange (PHX) provides healthcare cost management solutions including claims processing, network management, and bill review and audit services. It has offices across North America and over 200 clients. PHX combines automation with professional services to reduce costs and errors for payors. It has a commitment to customer service through its culture and customer advisory programs.
2. P A S S I O N | S K I L L | C O M M I T M E N T
OUR
DNA
Our Mission is to gain trust,
to deliver value and to make sure
our clients know we care.
Premier Healthcare Exchange, Inc. (PHX), based in Bedminster, New Jersey, with
satellite offices throughout North America, provides advanced network management and claims
integrity solutions for all types of healthcare Payors. PHX combines claim processing automation
with professional services to deliver a centralized approach to cost management, which maximizes
savings while dramatically reducing errors and turnaround time. All services are handled in-house
for maximum privacy and legal regulatory compliance. We also supply full technology
implementation, training and support for quick, seamless integration into any organization.
At PHX, we are your single source for a cost management solution to control health plan costs
utilizing a fully integrated approach. Our comprehensive portfolio of services is comprised of core
components which provide a complete wraparound solution for your business.
But the real “it” factor is also PHX’s greatest asset - its commitment to service. This is due to the
corporate culture at PHX, an all-encompassing culture that connects employees with clients and
promises sustainable results.
n A customer ‘first’ healthcare cost management company
n Based in Bedminster, NJ with offices in Atlanta, Tampa, Cleveland and Phoenix
n 220+ clients and a staff size of 200+
n Our expertise includes PPO Network Management, Claims Editing,
Bill Review Audit and Out-of-Network Services
3. PHX SERVICES
PHX’s product portfolio enables us to be your single
source for healthcare cost management, providing a
complete solution for your business, without the need
to outsource to external vendors.
PHX Network Management
PHX manages network relationships on behalf of self-insured employers, unions, TPAs, insurance
carriers and government entities. Our Network Management solutions decrease claim cost while
increasing operational efficiency for our clients. In fact, our suite of products enables us to fully
customize a network solution for our clients, which allows them to gain access to the best available
networks with the deepest discounts. PHX’s Network Management suite consists of:
ProPoint Primary – This is PHX’s traditional primary PPO product which features logoed,
in-network, in-area services utilizing the best available networks by market.
ProPoint National Access – National Access is a logoed, in-network, out-of-area product
which was developed in conjunction with our partners.
Custom Network Solutions – The PHX Custom Network helps clients who have their own
providers create a truly unique system, which increases top-line revenue and reduces the
utilization of providers or facilities competitive to the client.
PHX Claims Editing
Our Claims Editing service is a comprehensive claims editing system which produces fast, accurate
and customized code edits. Each claim is reviewed and cross-referenced with paid claim history
data to determine the appropriateness and accuracy of its coding in accordance with nationally
recognized coding guidelines. Staffed with certified professional coders, our claims editing
department manages the entire appeals process and provides quarterly maintenance updates.
PHX Bill Review Audit
Our Bill Review and Audit service utilizes state-of-the-art technology and a team of healthcare
professionals who perform pre-payment and post-payment audits on medical claims in order to
determine appropriateness of the billing. PHX’s three tiered approach to bill review and audit
utilizes clinical, financial and medical necessity reviews to: determine the appropriateness of billing;
uncover data entry, pricing errors or experimental/investigational charges; identify inappropriate,
unsubstantiated or improper charges; conduct cost to charge ratio analyses and other practices that
inflate billed amounts.
PHX Bill Review Audit is supported by a trained document retrieval team that gathers medical
records and other pertinent information required to complete our reviews and PHX absorbs the cost
associated as well.
4. PHX Out-of-Network Services
PHX’s integrated approach to out-of-network
claims ensures that our clients pay the
right price every time. PHX provides deep
discounts through direct claim negotiations
and rapid claims re-pricing however,
before any claims are finalized via a
negotiation or network repricing,
PHX will ensure the most appropriate cost
of the claim has been validated.
All claims are processed through the real
time claims edit engine to ensure accurate
coding/billing. In addition, benchmarking
data is utilized to ensure referenced based
methodology is enforced when applying
any discounts/savings.
Through PHX Out-of-Network Services,
you also get direct access to the PHX
Choice Network along with access to
many other national networks.
PEOPLE
Our expertise consists of a team of cross functional specialists to provide “hands-on” guidance to
you from the initial sales onboarding stage, to implementation, to daily operations.
n Our Account Management team’s top priority is managing the relationship with you.
Thorough understanding of your end use markets, your customer base and your healthcare
issues allows Account Management to build strong working relationships with you, ensuring
successful utilization of our services.
n Licensed RNs on staff have firsthand knowledge of procedures, allowing them to identify billing
inaccuracies with the best audit potential.
n Experienced Claim Negotiators are able to secure guaranteed discounts by detecting every
possible savings opportunity for above and beyond allowed discounts.
n Certified by ACPC, Professional Coders ensure accurate outcomes due to their knowledge of
current guidelines and regulation changes from the American Medical Association.
n Our highly skilled IT staff provide a fully HIPAA compliant storage system fully integrated with
best practice technologies, while maintaining infrastructure, software and applications.
n Expert Executive leadership who understand changing industry trends which provide you
with strategies that fulfill your healthcare goals and objectives.
5. PARTNERSHIP - CREATING CONNECTIONS THAT WORK FOR YOU
PHX understands the importance of partnering, especially in industries such as ours which are
experiencing rapid change. PHX successfully partners by teaming with customers at all levels in
the organization to understand goals and to build a shared vision. Moreover, by engaging you
throughout the entire process, we become a true partner, which means together we share risks,
responsibilities and rewards
COLLECTING THE VOICE OF THE CUSTOMER IS A STRATEGIC IMPERATIVE
We do this through a variety of tactics some of which include traditional market research, the
Customer Advisory Council (CAC), the Council for Operational Excellence (COE) and through our
Innovation Lab. These customer access points facilitate the exploration of issues that affect your
business and serve as a channel for PHX to collect insight on the needs of our customers, strategic
opportunities and tactical operational issues.
6. it’s about
pr
emier loyalty progr
am
The driving factor for growth is innovation – an integral component
to the success of any organization. For this reason, PHX created its
Innovation Lab: a venue where we channel our ideas and expertise
to design new products and services which add value for you.
The goal of the innovation lab is to accelerate the formation of
ideas in collaboration with internal staff, industry leaders and our
partnerships with our clients. Consequently, we’ve harnessed the
entrepreneurial spirit and innovation of key stakeholders and as
a result, the PHX Innovation Lab allows us to deliver enhanced
capabilities and technologies, as well as expand our service
offerings to you as a comprehensive solution provider in the industry.
We also feature an industry first customer loyalty program, called
the “U” Premier Loyalty Program. The ‘U’ PLP is designed to provide
recognition of the operations people with whom PHX interfaces with
daily. This program is an integrated, point-based system which delivers
streamlined benefits to our clients and in return enhances the end user
experience. Because PHX realizes the importance of customer loyalty
and satisfaction, the “U” PLP reflects our commitment to foster a long-
term relationship with you and reward you for your loyalty.
PHX Customer Advisory Council (CAC) members are recruited from all
of the key stakeholder groups within the healthcare cost management
industry. The mission of the CAC is multi-faceted as it serves as a
conduit for PHX to collect insight on the needs of our Customers and
use its members as an advisory panel on market level issues, strategic
opportunities and product development.
The Council for Operational Excellence (COE) recruits member from
the operational level of the healthcare cost management industry.
We believe tactical planning is an important component of every
company’s business plan as it provides a foundation for creating long
term strategic goals. With the ever-changing healthcare market, it’s
crucial to keep up to date with industry trends and operational needs
while incorporating this knowledge into your daily activities.
We believe our clients’ valuable feedback, partnered with our
industry expertise, uncover business strategies that are necessary
for viable growth.
C EO
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EXCELLENCE
C EO
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EXCELLENCE
C EO
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C U S T O M E R
A D V I S O R Y
C O U N C I L
