What is an LNP?
An LNP stands for "Large Network Partnership." It is a medical group, IPA, or health system that agrees to participate in PIC contractual agreements.

What services will PIC perform on behalf of an LNP?

PIC provides the infrastructure and financial management needed to successfully participate in and flourish under PIC’s core contractual agreements.

• Health Advocacy-Concurrent review facilitation, medical director consultation, health plan data warehousing, management, analysis and reporting, Disease management programs, utilization management programs, etc.

• Financial Management - Accrual based accounting and IBNR development of the health plan's financial and claims based data. Actuarial validation of key assumptions, etc.

• Physician Office Relations - PIC will assist the LNP office management with provider relations issues such as provider number and office information discrepancies, understanding QCCS reports, etc.

What will happen to my current contracts, capitation, and bonus payments?
Nothing. All of the physicians in the LNP retain their individual contracts with payers. This agreement is managed on a reconciliation basis. The agreement will be between the LNP and PIC. All of the current physicians' claims or cap payments remain unchanged. An additional surplus distribution may be available to the LNP if performance allows.

Will I have to change my referral patterns or refer only to PIC specialists?
No. Your existing methodologies remain unchanged. You may receive information regarding "Best Buy/Worst Buy" cost comparisons which could be used as additional background for choosing the most cost effective quality provider for any particular service. The choice will be up to you.
 

What does PIC receive in return?
PIC will be paid an administrative fee and will receive a share of any surplus.