To promote high-quality, cost-effective medical care that is physician driven, financially sustainable and valued by health care stakeholders.

The CSMS-IPA offers a variety of organizational, staff, and consumer based products that add clinical and financial value to you, your practice and your patients. These include:

• Partners for Quality and Cost Effective Care (P4Q) – Access to a pay for performance program that was developed (and continues to evolve) in conjunction with IPA physicians. P4Q provides physicians with the opportunity for bonus compensation in addition to, but separate from, established fee for service reimbursement. Key variables in the program include measures in the areas of Quality, Cost Indexes, Generic Utilization, Health Care Technology adoption and patient access.
• Market Based Fee Development – Independent Health Care consultants work with the IPA to annually evaluate market information with regard to fee for service reimbursement. The survey information obtained aids the IPA with review of fee schedules that are specialty sensitive and aligned within the competitive managed care markets. Key to this initiative is the cooperation of IPA practices. Information on trends in the market place is critical to maintaining market competitive fees. If/when contacted by the third party, your participation in these programs is necessary to the success of the program.
• Network Management – IPA staff provides resources to the IPA practices where difficulty in accessing plan resources has been encountered. While the vast majority of situations are handled by health plan representatives, occasionally it is appropriate to escalate key issues through the IPA to focus the attention of health plan management on issues affecting IPA practices. If you encounter difficulty in obtaining resolution to policy, program or claim issues, please do not hesitate to contact us.
• Policy Review Network - The IPA maintains a network of consulting physicians in virtually all medical and surgical specialties who review new and revised Health Net medical policies for clinical and scientific validity prior to distribution to the Connecticut physicians.
• Quality Management Programs – Provide valuable data to your practice on the clinical needs of your patients in regard to services such as mammography and diabetic retina exams. Health plan quality initiatives are reviewed by this committee and valuable input is provided.
• Individualized Physician Management Services – Our clinical staff can assist you and your practice in meeting utilization and coding standards. We utilize state of the art software for evaluation of program specific (published) criteria. If selected or requested for review, reports can be produced that you can use to aid in compliance with AMA / CPT^® coding standards. If applicable, we will meet with you and your staff to review these reports and offer suggestions on how to comply with established standards. Our on-staff medical director also offers the opportunity for peer to peer interface. 
• Credentialing Application Support – We will work with your practice to ensure that all necessary documents are in place and submitted for credentialing with Health Net of Connecticut.
• Educational Opportunities – Quarterly newsletters, periodic statewide meetings, continuing education programs, advisory groups and up to the minute "fast faxes" keep you and your practice up to date with the latest information.
• Valuable Products and Services - The CSMS-IPA continues to negotiate value-added arrangements with various organizations and businesses that help to make your practice more efficient and profitable. Some current arrangements are:
  • Staples Discount Program - This is a broad ranged discount program on catalog listed office supplies. Discounts range from 40 – 60% for IPA members.
  • EPocrates® Software – Drug and Formulary reference software that can be downloaded onto a handheld device or accessed through the internet on a personal computer. Health Net formularies have been added to the other formulary information (including Medicare Part D) that is provided free to all IPA practitioners.
  • Kelson Vaccine Purchasing Program – Participating IPA members have access in the vaccine Purchasing Program with no enrollment fee costs. This includes favorable pricing and payment terms for all purchases. They offer a full spectrum of pediatric, adult, flu and travel vaccines (subject to availability).
  • Transworld Systems revenue recovery services - A discounted accounts receivable program that specializes in both self-pay and insurance resolution revenue recovery services.
  • NHXS- eobResolve™ - National Healthcare Exchange Services provides turnkey solutions to improve payment accuracy and reduce dispute resolution costs for medical professionals. CSMS-IPA will make eobResolve™ available to its physician membership in order to review, audit, and when appropriate, automatically appeal underpayments on medical claims. The eobResolve™ "rules engine" maintains current fee schedule, pricing, and bundling edit logic for each payor, greatly improving the sensitivity of the audit and making it cost effective to recover even small dollar underpayments.
  • Emdeon™ ClinicianRx - The CSMS-IPA, Health Net of Connecticut, Inc. (Health Net) and Emdeon™ are pleased to announce that an opportunity to provide e-Prescribing software to all CSMS-IPA physicians on a subsidized basis is now available.

CPT® is a trademark of the American Medical Association.