Orlando Harmon
PHCS (Private Healthcare Systems) is a network of medical doctors and facilities that health plans use to offer a broader choice of healthcare providers to their members. PHCS is not an insurance company, and it does not pay claims or guarantee health benefit coverage. Instead, it offers a variety of health insurance plans, including preventive care, emergency services, and prescription medications. Members have the right to choose healthcare providers from the PHCS network, consistent with the terms of their health benefit plans and applicable laws. The PHCS network includes more than one million healthcare providers nationwide, and members can expect significant cost savings when visiting in-network providers.
| Characteristics | Values |
|---|---|
| Type of Insurance | Limited Benefit Plan |
| Number of Healthcare Providers | More than 1 million providers nationwide, including 920,000 practitioners, 4,800 acute care hospitals, and 87,000 ancillary facilities. |
| Choice and Flexibility | Broad access to nearly 4,400 hospitals, 79,000 ancillaries, and more than 700,000 healthcare professionals. Health plans can customize the network to meet their unique needs. |
| Cost Savings | Negotiated discounts result in significant cost savings when visiting in-network providers. |
| Quality | Rigorous reviews of provider credentialing and re-credentialing policies and procedures. |
| Billing | Pre-Payment Integrity services are embedded to correct improper billing early in the process. |
| Accreditation | The only nationwide, independent PPO to be accredited for credentialing by NCQA. |
| Complaint Resolution | MultiPlan has a formal complaint resolution process to address concerns about healthcare from network providers. |
| Insurance Provider | MultiPlan, Inc. (not an insurance company, does not pay claims, and does not guarantee health benefit coverage). |
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What You'll Learn
MultiPlan and PHCS are not insurance companies
MultiPlan and PHCS (Private Healthcare Systems) are not insurance companies, but they are two of the largest providers of healthcare networks in the United States. They provide networks of medical doctors and facilities that health plans use to offer their members a broader choice of healthcare providers at discounted rates.
MultiPlan and PHCS are network providers, not insurance providers. This means they do not provide benefits, nor do they pay medical claims. They do not administer benefit plans, and they do not guarantee health benefit coverage. If you see the MultiPlan or PHCS logo on your health insurance card, it means you can use their websites to search for a doctor or medical facility that will accept your insurance plan. However, questions about coverage or benefits should be directed to your health insurance company.
MultiPlan and PHCS work with multiple types of insurance plans, including limited-benefit health insurance plans. Limited-benefit plans are designed to supplement regular health care policies, not replace them. They provide considerably less coverage. For example, a limited-benefit plan may not cover pre-existing conditions or prescription drugs.
The PHCS Network is the largest independent, nationwide primary preferred provider organization (PPO). It includes more than one million healthcare providers nationwide, including 920,000 practitioners, 4,800 acute care hospitals, and 87,000 ancillary facilities. The MultiPlan Network is a nationwide complementary PPO network.
MultiPlan and PHCS are subsidiaries of Claritev, which offers a version of the PHCS Network that is tailored specifically for use with RBP services. The PHCS Network for Value-Driven Health Plans includes practitioners and ancillary services and is available exclusively when paired with HST’s RBP service for hospitals.
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MultiPlan and PHCS are networks of medical doctors and facilities
MultiPlan's PHCS Network is the largest independent, nationwide primary preferred provider organization (PPO). It is the preferred choice for health plans that want a provider network with the flexibility to meet their unique needs. Plans get administrative ease without sacrificing provider access, savings, and quality for health plan members. The PHCS Network includes more than one million healthcare providers nationwide, including 920,000 practitioners, 4,800 acute care hospitals, and 87,000 ancillary facilities. Average savings by claim type are 42% for practitioners, 28% for inpatient, 24% for outpatient, and 46% for ancillary facilities. With the PHCS Network, pre-Payment Integrity services are embedded in the network to correct improper billing early in the process.
The PHCS Network can be used by itself or as part of a total solution that helps plans manage the cost of care with only one claim submission. MultiPlan now offers a version of the PHCS Network that is tailored specifically for use with RBP services. The PHCS Network for Value-Driven Health Plans includes practitioners and ancillary services and is available exclusively when paired with HST’s RBP service for hospitals. Healthcare systems appreciate the administrative ease of dealing with one company offering a unified network + RBP services, and health plan members appreciate the practicality and simplification of using one app or website to find care.
Health plans can customize the PHCS Network in almost any way needed, accessing nationwide or carving out specific geographies, excluding or including only specific provider types/specialties, as the primary PPO or to extend the service area of another network, with or without tiered in-network benefits. Claritev contracts with over 1.4 million healthcare providers and facilities to add value to any healthcare payor’s network access strategy. The PHCS Network is available in a variety of configurations, including outside the plan service area, to extend local HMO or PPO coverage nationally.
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PHCS offers a range of health insurance plans
PHCS (Private Healthcare Systems) offers a range of health insurance plans tailored to fit different lifestyles and needs. PHCS is a network of medical doctors and facilities that health plans use to provide a broader choice of healthcare providers offering discounted services to their members.
The PHCS Network is the largest independent, nationwide primary Preferred Provider Organization (PPO). It includes more than one million healthcare providers nationwide, including 920,000 practitioners, 4,800 acute care hospitals, and 87,000 ancillary facilities. The network can be used by itself or as part of a total solution that helps plans manage the cost of care with only one claim submission.
PHCS offers negotiated discounts that result in significant cost savings when visiting in-network providers, helping to maximize your benefits. The PHCS logo on your health insurance card indicates that you are entitled to these discounts.
PHCS provides a variety of health insurance plans, from preventive care to emergency services and prescription medications. Their plans offer flexibility to meet unique needs, providing administrative ease without sacrificing provider access, savings, and quality for health plan members.
It is important to note that PHCS is not an insurance company and does not pay claims or guarantee health benefit coverage. Instead, they partner with insurers and other payers to offer a range of services, including network-based solutions and data analytics, to make healthcare more affordable and accessible.
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PHCS is the largest independent, nationwide primary PPO
PHCS is the largest independent, nationwide primary Preferred Provider Organization (PPO) network. It is a popular choice for health plans that want a provider network with the flexibility to meet their unique needs. PHCS offers administrative ease without sacrificing provider access, savings, and quality for health plan members. The network includes over one million healthcare providers across the country, including 920,000 practitioners, 4,800 acute care hospitals, and 87,000 ancillary facilities.
The PHCS Network can be customized to meet the specific needs of health plans. Plans can access the network nationwide or focus on specific geographies, and include or exclude certain provider types and specialties. The network can be used as a primary PPO or to extend the service area of another network. PHCS also offers significant cost savings to its members when they visit in-network providers, helping to maximize their benefits.
MultiPlan, Inc., which operates the PHCS Network, does not offer insurance, administer benefit plans, or pay claims to doctors or facilities in the network. Instead, it provides a broad choice of healthcare providers who offer discounted services to members. Members can choose healthcare providers from the MultiPlan or PHCS network, in line with the terms of their health benefit plans and applicable laws.
The PHCS Network is also the only nationwide, independent PPO to be accredited for credentialing by the NCQA. This means that MultiPlan applies rigorous criteria when selecting providers for participation in the PHCS Network, ensuring that members receive high-quality healthcare services.
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PHCS provides flexibility, savings, and quality
PHCS (Private Healthcare Systems) is a large network of medical doctors and facilities that health plans use to provide a broader choice of healthcare providers offering discounted services to their members. It is the largest independent, nationwide primary Preferred Provider Organization (PPO) network, with over a million healthcare providers.
Flexibility
The PHCS Network can be used by itself or as part of a total solution that helps plans manage the cost of care with only one claim submission. Health plans can customize the PHCS Network in almost any way needed, accessing nationwide or carving out specific geographies, excluding or including only specific provider types/specialties, as the primary PPO or to extend the service area of another network, with or without tiered in-network benefits.
Savings
The PHCS Network provides negotiated discounts that result in significant cost savings when you visit in-network providers, helping to maximize your benefits. The average savings by claim type are 42% for practitioners, 28% for inpatient, 24% for outpatient and 46% for ancillary facilities. PHCS has pre-negotiated rates with healthcare providers, meaning lower out-of-pocket costs for medical services compared to visiting out-of-network providers.
Quality
MultiPlan, which operates the PHCS Network, applies rigorous criteria when credentialing providers for participation in the network, so you can be assured you are choosing your healthcare provider from a high-quality network. The PHCS Network is the only nationwide, independent PPO to be accredited for credentialing by NCQA.
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Frequently asked questions
PHCS is a network of medical doctors and facilities that health plans use to provide a broader choice of healthcare providers offering discounted services to their members.
If you have the PHCS logo on your health insurance card, you have access to the PHCS Limited Benefit Network.
The PHCS Limited Benefit Network provides access to a large number of healthcare providers, including practitioners, acute care hospitals, and ancillary facilities, with significant cost savings when visiting in-network providers.
You can use MultiPlan's Online Provider Referral System to find a provider in the PHCS Limited Benefit Network. You can also call MultiPlan at (888) 371-7427 or use the provider search tool on their website.
