Imagine a network where patients can go to any provider they want, knowing in advance which providers can best meet their needs – a network where insurers have the peace of mind of knowing that they will pay a fair price for quality service. At PayerFusion, we have transformed network access to provide patients with the freedom of choice and our provider recommendations (based on cost and quality) to eliminate guesswork, while ending the gaming of the system to chase discounts on ever-inflated prices. We anchor our cost reductions to the actual cost of services and an understanding of fair rates of reimbursement by services to be rendered, provider and geography.
PayFuseNet is a natural fit for payers who provide open access plans – without the premium price. Our cost-plus methodology removes all network barriers because the reductions achieved are not contingent upon the providers’ network membership. Rather, they come from our unique approach to claims administration.
Our international cost containment services range from card acceptance and direct billing to discounts on some claims. Network presence established in Puerto Rico, the Caribbean, Central (including Mexico) and South America, Eastern Europe, New Zealand, South Africa, and Turkey. Networks in development include Egypt, Turkey, India and China.
A healthcare provider network is only as good as the relationships formed between payer and provider
Our providers welcome PayfuseNet and appreciate our fair, efficient and transparent approach to reimbursement. We only allow authorized users to access our network and always make sure to notify our providers of those users.
With experience on every side of the healthcare industry, we have developed a set of best practices and efficiencies that reduce your administrative burden.
We are continually expanding PayfuseNet to encompass a greater number of qualified providers and facilities.
Dental Network
The PayerFusion Dental Network is provided as either a covered benefit or simply to access significant savings. We offer insurers and their members a reduced-fee dental program designed for consumers looking to maintain their oral health and minimize their dental care expenses.
All network providers are independent contractors in private practice who are reviewed and credentialed to ensure adherence to quality standards. General dentists participating in the program have agreed to accept the contracted rate as payment in full for services performed. Specialists are easy to access in the network and provide discounts according to their individual fee schedules.
Participants in the Dental Discount Program will receive a membership card. If included as part of a medical insurance program, the dental ID will be included on the back of insured’s medical cards. Members can access dentists through PayerFusion’s provider search (myprovidersearch.com). We can coordinate appointments for members upon request to ensure a hassle-free experience. These discounts are available to members and their families throughout the dental network with no limit on usage. Enrollees arrange for needed dental care, including payment, directly with the network provider. Enrollees are responsible for the entire cost of the dental care provided.
The discount program is NOT INSURANCE (although the network and savings can be incorporated into insurance plans with dental benefits). It is a reduced fee for service program that is designed to save your members money on most of their dental needs. Their final cost will depend upon the type of dental work performed as well as the geographic location.
Fees for the dental work performed are due at the time service is rendered unless other arrangements are made with the dentist’s office. There are no out of network benefits payable in this program. The PayerFusion Dental Network discounts cannot be combined with any other discount dental program.
Pharmacy Network
Our extensive pharmacy network provides members with significant savings and personalized service. We can customize both coverage and member services to fit your needs, ranging from carve out networks to phone greetings with your company name.
Our Pharmacy Discount Card provides members with the option of enrolling and printing their cards online. On-demand distribution allows for members to travel throughout the U.S. prepared for any situation requiring them to purchase medication.
The Pharmacy Discount Card is an easy add-on to existing policies as additional benefit.
- 45% average savings to client
- No card numbers required
- Massive distribution volume
Premiere Expatriate Services
- Complete Pharmacy Benefits Management (PBM) service including customized services for generic and brand name medications
- Straight cash and carry discount card- minimum administrative burden
- Mail-in Pharmacy Services- medications submitted and distributed via mail
Vision Network
Our optometrists are Therapeutic Pharmaceutical Agent (TPA) certified and our ophthalmologists are American Board of Ophthalmology (ABO) certified. They are located nationwide in a variety of office settings and offer early morning, evening, and weekend appointments, and many accept walk-ins. They have a wide selection of frame brands, from classic styles to the latest in designer brands—making it easy for you to get your exam and eyewear in one convenient location.
Benefit Features
- No limit on number of times services may be used during the year 30 day unconditional, money-back satisfaction guarantee-if for any reason a member is not satisfied with a purchase at the retail locations or through the mail, the merchandise may be returned within 30 days for a full refund or exchange.
- Low price guarantee on eyeglasses- if a member finds a lower price anywhere else on the exact same complete pair of prescription eyeglasses purchased at a participating location within 30 days of purchase, the difference will be refunded.
- 24-hour phone and Internet search for locating a participating retail provider
Provider Network
Our network of 12,000 vision service providers is the most comprehensive in the United States and includes:
- Ophthalmologists
- Optometrists
- Independent optical centers
- Regional chains
- Department store optical centers (Sears Optical, Target Optical, JCPenney Optical)
- National chain locations (Pearle Vision, LensCrafters)