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Payer Contracting
MPS represents physicians from a wide range of physician specialties that have offices throughout Connecticut to provide physician services to Connecticut residents.
Through payer contracting, MPS establishes the kind of two-way communication required in value-based payer situations.
In a value-based arrangement, reimbursement is based on documented quality of care. As a result, these arrangements usually involve more extensive data reporting and payer collaboration.
MPS provides all of the analytical data required to ensure favorable contracts with insurers and provides the kind of care coordination and collaborative negotiations needed to succeed in this environment.
MPS and its physician members are actively engaged in quality improvement activities, both on an inpatient and ambulatory basis, working together to measure and continually improve the quality and value of the services they provide.
These clinical quality programs make MPS and its physicians valuable partners with payers. The clinical quality and clinical integration programs developed by MPS entail a wide range of products, services, and opportunities for physician participation.
Currently, MPS contracts with the following health plans:
- Aetna - Fee for Service & Value-Based Contracts
- Anthem - Medicare Advantage
- ConnectiCare - Fee for Service
- CHN PPO
- First Health/Coventry
- Harvard Pilgrim Health Care - Fee for Service
- MultiPlan, Inc. / Private Health Care Systems
- Prime Health Services - Primarily State Employee Worker's Compensation
- Three Rivers Provider Network, Inc.
- WellCare - Medicare Advantage
MPS staff also assists MPS physician members and their office staff with all phases of the health plan credentialing process.
