About Us
Available Networks
The SuperMed PPO
The SuperMed PPO is a Preferred Provider Organization and consists of contracts in Ohio and certain regions in Indiana and Kentucky.
Provider Reimbursement
We work directly with doctors and hospitals to negotiate provider discounts and
reimbursement.
Physicians
We use the following tools to determine competitive reimbursement levels for physicians
and other healthcare professionals:
- Claims history and current payment levels
- Medicare fee schedules
- Health Care Financing Administration (HCFA) resource-based relative value scale
- Wholesale prices (where applicable)
- Financial and statistical indicators
- Geographic physician billing practices
- Site of service (facility vs. non-facility)
Providers who participate in the SuperMed Network agree to accept our negotiated
rates as payment in full for covered services. They are also required to take part
in managed care initiatives aimed at reducing costs and verifying the medical appropriateness
of all procedures.
Hospitals
We contract with hospitals using varying methods of reimbursement, depending on
the facility's volume of claims and utilization patterns. These payment methods
are flexible to accommodate the hospital's specific needs and other incentives to
help control costs and utilization by:
- In patient diagnosis-related grouping
- Per diem rates
- Percent-off charges
- Outpatient ambulatory patient grouping
- Charge increase limitations
- Inlier and outlier minimums and maximums
- Fixed outpatient pricing
Quality of Service
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Customer Service:
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Knowledgeable customer service staff is available
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Monday-Thursday
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7:30am to 7:30pm (EST)
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Friday
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7:30am to 6:00pm (EST)
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Saturday
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9:00am to 1:00pm (EST)
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Direct Claims Submission:
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Claims are submitted directly to Medical Mutual to eliminate unnecessary paperwork
for members.
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Repricing Services:
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Two billion claims are repriced annually. 98% of all claims are processed within seven
calendar days.
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Provider Location Services:
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Members can ensure maximum cost savings by verifying the status of providers in
the network.
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Provider Recruitment:
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We receive requests from employees or employers to add a provider to our network.
This initiates our discussions with providers to add them to the network.
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