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Ancillary healthcare services include a broad array of services that supplement or support the care provided by hospitals and physicians. These ancillary services are provided to members as benefits under group health, workers compensation plans and Medicare plans.

Through its contracts with over 4,900 service providers and over 36,000 sites nationwide, ACS is able to offer its clients direct cost savings by functioning as a single point of contact for managing a comprehensive array of ancillary benefits. ACS benefits management services include processing and repricing the claims, submitting claims for payment, receiving and disbursing claims payments and performing customer service functions for its clients and contracted providers. For preferred provider organization ("PPO"), third party administrator ("TPA") and similar clients, contracting with ACS also allows the clients to market comprehensive, efficient and affordable ancillary service benefits to their payor customers. 

As part of its ancillary benefits management services, ancillary providers submit claims for services performed for covered members. ACS re-prices these claims under the relevant payor fee schedule, performs electronic data conversion and HIPAA services, and submits the re-priced claims to the appropriate payors. After adjudication of the claims by the Payor, the Payor issues an Explanation of Benefits, Explanation of Payment and check for each claim. In most cases, these checks are sent to American CareSource Holdings. American CareSource Holdings then pays the providers under the relevant provider fee schedule. 

As we work with new potential clients, we are able to specifically identify the cost savings opportunities our network of providers can deliver to our payors. We do this through our proprietary software and analytic methods, which enable us to analyze our clients' claim history on an exact match, case by case method. This process accurately depicts the geographic match of our network with their insured population and identifies the potential cost savings from our negotiated rates. 

The value-added services that ACS provides to its clients include the following: 

Ancillary network analysis and network customization. American CareSource analyzes the available claims history from each client and develops a specific plan to meet their needs. This analysis identifies high-volume providers that are not already in-network and develops a strategy to create a network that efficiently serves the clients needs. 

Ancillary reimbursement. American CareSource uses its network analysis to develop a custom reimbursement level for its clients. ACS also processes denials and appeals for clients and contracted providers. ACS consolidates Payor payments and delivers one check to providers with detailed explanation of payment. 

Ancillary network management. American CareSource manages ancillary service provider contracts, reimbursement and credentialing. This provides administrative benefits to ACS clients and reduces the burden on providers who typically must supply credentialing documentation and engage in contract negotiation with separate Payors. 

Ancillary claims management. American CareSource manages ancillary claims flow, both electronic and paper. ACS also performs a number of customized processes that add additional value for each client. 

American CareSource estimates that at least 80% of all ancillary claims are submitted on paper. ACS is able to provide a conversion of these paper claims into the HIPAA-compliant Electronic Data Interchange ("EDI") form.

Service Categories 

Ancillary services represent one of the fastest growing components of healthcare costs. The ACS network includes 26 primary specialties with over 30 subspecialties. Primary services include:


Service Group

Specialty Category

Included Subspecialties

Testing

Laboratory

Radiology / Imaging

Cardiac Monitoring

Sleep Diagnostics

Genetic Testing

 

Therapies

Alternative Therapies

Acupuncture

Massage Therapy

Dialysis

 

Chiropractic

 

Infusion Services

Specialty Pharmacy

Home Health

 

Outpatient Rehab

Occupational & Physical Therapy

Speech Therapy

Pain Management

Physician Alternatives

Walk-In Clinics

 

Urgent Care Center

Post-Acute Hospital Services

Hospice

 

Inpatient Rehab

Occupational & Physical Therapy

Long Term Acute Care

 

Skilled Nursing Facilities

 

Surgery Center

Lithotripsy

Medical Devices

Durable Medical Equipment

Hearing Aids

Implantable Devices

 

Orthotics & Prosthetics

 

Diabetic Supplies

 

 

Other Services

Podiatry

 

Transportation

 

Vision

 


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