PayFuseNet Capabilities

5200 Blue Lagoon Dr. Suite #100  Miami, FL 33126  (305) 760 - 8739www.payerfusenet.com 1

OVERVIEW
PayFuseNet gives your members freedom of choice while
maximizing your savings through our cost-plus methodology.
• Network presence established across the USA,
Puerto Rico, the Caribbean, Latin America, Europe,
Asia, New Zealand and South Africa.
• Directly contracted and managed to ensure strong
provider relationships and attain the most value for
our clients.
• Fully compliant with all USA federal and state
regulations.
• Zero-balance billing guarantee, worry-free access to
care.

OVERVIEW
A provider network is only as strong the connections
between all parties in the healthcare equation.
Advocacy on behalf of patients and plan sponsors to address
care needs and maximize opportunities for cost savings. We
can coordinate care in advance and work with all parties to
manage claims already incurred or in process.
Expertise attained through over 75 years of combined
experience on all sides of the healthcare business means
there’s never a situation we can’t handle.
Compliance - Each claim that we adjudicate is validated
relative to regulatory and compliance guidelines to ensure
viability of payment based on the requirements of federal and
state guidelines.

PROVIDER NETWORK OPTIONS

THE NETWORK WITHOUT WALLS
With PayFuseNet, there is no such thing as an
“out-of-network” provider.
• Providers are contracted on a “cost-plus” basis
with a competitive fee schedule that is fair to all
parties.
• Our cost-plus reimbursement methodology
utilizes real cost & quality data to determine a
fair retail price for medical services. This
approach leads to fair and sustainable pricing
for plan sponsors and their members.

THE NETWORK WITHOUT WALLS
Our approach is the key to your savings, not provider
membership and discounts on inflated charges.
• When a member visits a
provider that has not been
contracted, we will invite the
provider to join our network
• With those not ready to join
the network, we will settle the
claim on a cost-plus basis and
offer immediate payment as an
incentive to reduce the billed
charges down to cost-plus
pricing.

COST-PLUS REIMBURSEMENT
Cost-Plus reimbursement creates significant savings for
plan sponsors while allowing providers a fair profit based
on the actual cost of service.
• Each claim is compared to national data reported by state and
federal agencies, as well as to our own proprietary database
• Utilizing this data, we determine the actual cost of
service, needs of the provider to offset losses from providing
under-funded care and the fair retail cost of the service
provided.
• Our expertise and experience on all sides of the healthcare
industry gives us an invaluable advantage in negotiating
effectively and maintaining long-term relationships.

COST-PLUS REIMBURSEMENT
Rather than pursuing discounts
on continually inflating prices,
we leverage real cost and quality
data, mined with our own
unique algorithm to achieve
superior and fair pricing.

PAYFUSENET VERSUS PPO
PPO networks simply do not address the realities of today’s
policies and the new challenges of the healthcare landscape.
• PPO’s were designed for policies that are PPO in nature which
carry differentials and incentives for in & out of network access.
• These networks are now being used as a desperate means to
achieve discounts on highly inflated retail prices. PPO networks
are not concerned with the true cost of healthcare services.
• With PPO networks becoming so extensive, the concept of
“discount for volume” is nonexistent. Without this leverage, PPO
networks cannot effectively control billed charges and chase
discounts on inflated prices that continue to increase.

KEY ADVANTAGES
PayFuseNet is designed to meet challenges and changes
of today’s healthcare environment.
• Specifically developed for self-funded
employers and international insurers seeking
the freedom of an open access plan without
the premium price.
• Our approach removes all network barriers
because the reductions achieved are not
contingent upon provider network
membership.

KEY ADVANTAGES
PayFuseNet focuses on the needs of all parties in the
healthcare equation- payer, patient & provider!
• Our cost-plus reimbursement methodology
combined with innovative claims
administration strategies results in the fair and
stable pricing of healthcare services.
• We provide plan sponsors and members with
the highest level of customer service to ensure
a hassle-free and positive experience

PayFuseNet Capabilities

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