InterWest has become the PPO network of choice for many payors around the country. Today, over 170,000 people are covered under health benefit plans that utilize the InterWest PPO network.

InterWest is different from other PPO networks in that it is not aligned with a particular hospital or insurance company. It is an independent preferred provider organization aimed at serving the needs of payors wanting access to a broad-based, cost-effective delivery system to support their health benefit plans.

Provider Network

InterWest Health has over 15,000 participating hospitals, physicians and other providers participating in its PPO network. These participating providers have agreed to make their services available to payors under state-of-the-art contract terms at competitive prices.

Physicians and other practitioners are paid on a fee-for-service basis according to maximum allowable fee schedules or discounted charges. Hospitals and other facilities are paid on the basis of individually negotiated discounts, per diems or per case rates.

The payment arrangements that InterWest has negotiated with participating providers are among the best in the region, giving payors access to significant price discounts with no balance billing to enrollees.

Participating providers are credentialed at the time of enrollment and every 3 years thereafter according to standards that were developed based on NCQA and URAC guidelines.

Claims Repricing

InterWest Health has recently implemented an in-house repricing solution to help improve the efficiency and accuracy of how claims are repriced. The system is HIPAA compliant and offers flexibility in how claims are received and transmitted to payors. InterWest's preferred approach is to have claims repriced under this new system; however, exceptions will be considered for payors with a large claims base that meet certain criteria.

For more information about this service, please contact InterWest.

How to Access Network

To access InterWest's PPO network, payors need to sign a Health Care Network Access Agreement. Payors are welcome to use their own contract form if they prefer, as long as the language of the contract is consistent with the manner in which InterWest does business and the arrangements the company has with providers participating in the network.

InterWest charges payors a nominal access fee for use of its PPO network. The access fee can be structured as either a per employee per month (PEPM) rate or a percent of savings. Additional fees are charged for repricing and the printing of directories, if done by InterWest.

Payors who utilize the InterWest network are expected to:

• Use the network to support PPO benefit plans with patient steerage
  
• Put the InterWest logo on ID cards, along with a toll free number participating providers can call for eligibility and benefit information
  
• Make reference to InterWest on Explanations of Benefits (EOBs) as the PPO network used to reprice claims
  
• Designate an individual whom InterWest can contact for assistance in resolving EOB and other issues

For information on how to access our PPO network, please contact InterWest at (406) 542-1912 or toll free at (877) 542-1912.

Benefits of Using InterWest

InterWest is specifically designed to meet the needs of payors wanting access to a quality, cost-effective network of participating providers to support their health benefit plans. Benefits of using the InterWest PPO network include:

• Largest, most comprehensive PPO network in the region with competitive pricing
  
• Fast, convenient access under one contract signature
  
• Easy implementation and new group enrollment
  
• Friendly, responsive service
  
• Direct access to local PPO network