PPO Solutions
tailored to meet
your goals.

PPO Solutions

Proper PPO management is more important today than ever before.

Why are more successful dental practices participating in PPO insurance?

Over the past 10 years, there has been a major shift in dental benefit enrollment. Today, nearly 80% of dental patients have access to dental benefits. This makes the reasons for participating in PPO Insurance networks that much more important to the long term success of your practice.

Here are some of the top factors driving PPO participation decisions:

  • Competition for patients is increasing
  • More Americans than ever have a dental benefits
  • Consumers are more cost conscious
  • The number and size of DSO’s continues to increase
  • Rapidly increasing ER Healthcare premiums
  • Heightened emphasis on in-network providers

A few things to consider about PPO planning.

1
Plans to Join.

Strategy to attract and retain patients.

2
Plans to Leave.

Understand the implications of leaving and break even analysis.

3
Plans to Optimize.

Strategic contracting to maximize reimbursements.

Three steps to effective PPO management.

By evaluating objective data and a clear understanding of the goals for your practice - combined with our expertise in negotiating and managing PPO programs, we will help you achieve your financial objectives – one step at a time.

STEP 1 Analyze
Evaluate your market and your business goals – and develop a tailored insurance strategy:
  • Maximize reimbursements
  • Optimize PPO negotiation
  • Simplify network complexity
STEP 2 Implement
Implement all participation requirements, inncluding:
  • Credentialing
  • Term plans
  • Opt-in/out
  • Mirror providers
  • Acquistion (TIN)
STEP 3 Manage
Monitor practice metrics and manage to ensure that the program is delivering the desired results:
  • Train Office Staff
  • Evaluate insurance performance
  • Provide EOB support

PPO expertise you can count on.

Put our experience with Negotiation and Optimization to work for you.

The landscape of network leasing and partner relationships can be very confusing and can lead to a provider being paid under a fee schedule they did not expect.

Five Lakes can address these challenges thanks to our substantial expertise navigating the complexity of PPO Insurance Carrier networks. Our experience with PPO negotiation and Plan Optimization is invaluable in helping our clients make the best possible PPO decisions by understanding the intricacy of carrier relationships and clarifying confusing issues – such as state regulations, geographic alliances and multi-level fee schedules.

An overview of our PPO services.

As dentist entrepreneurs get their practice off the ground, Five Lakes helps negotiate with the insurance carriers optimizing the pathway to a proper PPO strategy and predictable cashflow. This is a very delicate time for a practice, and effective PPO management can save – not just money – but also years of frustrations. Below is a list of some of the factors that we take into account:

Setting Office Fee
Schedule


Access to new
patients


Carrier Fee
reimbursement
negotiation


Employer Benefit
Offering


Credentialing


A significant number of practices go through transition in the ever increasing trend to group practice ownership and DSO strategies. Our turnkey solution developes and executes your participation strategy for your new office. We will help you understand the proper PPO networks to participate with, negotiate higher fee schedules, credential into the networks and provide billing solutions in a timely manner.

In depth analysis of
PPO participation


Ranking of
insurance plans
based on profitability


Auditing and help
setting office fees


Credentialing services
and TIN changes


Marketplace analysis


The private practice and small group practices have been at the core of Five Lakes since the beginning. Whether you are a GP, Pedodontist, Orthodontist, Endodontist, Periodontist or an Oral Surgeon the Five Lakes PPO Analysis and Management services will result in enhanced reimbursements and set the stage for long term compounding returns.

Market Place analysis
of demographics,
employers &
competitors


Detailed PPO
Insurance Analysis


Set Game-plan for
PPO participation


Negotiate and
Optimize the PPO
Reimbursement


Implement the PPO
Strategy through PPO
Management Services


As a large group or DSO, you have unique challenges and opportunities. Our PPO management services allow your group practices to set a strategy to maximize profitability through alignment and implementation of an overall strategy. Five Lakes works with practice groups of all sizes and business processes. Our services function as a member of your team to fully develop your PPO Insurance portfolio.

Develop strategic
PPO participation by
state or region


Set Consistent PPO
contracting


Improve
reimbursements to
maximize profitability


Enhance RCM process
effectiveness


Increase Practice
overall value and
EBITDA


As dentist entrepreneurs get their practice off the ground, Five Lakes helps negotiate with the insurance carriers optimizing the pathway to a proper PPO strategy and predictable cashflow. This is a very delicate time for a practice, and effective PPO management can save – not just money – but also years of frustrations. Below is a list of some of the factors that we take into account:

Setting Office Fee
Schedule


Access to new
patients


Carrier Fee
reimbursement
negotiation


Employer Benefit
Offering


Credentialing


A significant number of practices go through transition in the ever increasing trend to group practice ownership and DSO strategies. Our turnkey solution developes and executes your participation strategy for your new office. We will help you understand the proper PPO networks to participate with, negotiate higher fee schedules, credential into the networks and provide billing solutions in a timely manner.

In depth analysis of
PPO participation


Ranking of
insurance plans
based on profitability


Auditing and help
setting office fees


Credentialing services
and TIN changes


Marketplace analysis


The private practice and small group practices have been at the core of Five Lakes since the beginning. Whether you are a GP, Pedodontist, Orthodontist, Endodontist, Periodontist or an Oral Surgeon the Five Lakes PPO Analysis and Management services will result in enhanced reimbursements and set the stage for long term compounding returns.

Market Place analysis
of demographics,
employers &
competitors


Detailed PPO
Insurance Analysis


Set Game-plan for
PPO participation


Negotiate and
Optimize the PPO
Reimbursement


Implement the PPO
Strategy through PPO
Management Services


As a large group or DSO, you have unique challenges and opportunities. Our PPO management services allow your group practices to set a strategy to maximize profitability through alignment and implementation of an overall strategy. Five Lakes works with practice groups of all sizes and business processes. Our services function as a member of your team to fully develop your PPO Insurance portfolio.

Develop strategic
PPO participation by
state or region


Set Consistent PPO
contracting


Improve
reimbursements to
maximize profitability


Enhance RCM process
effectiveness


Increase Practice
overall value and
EBITDA


Ready to get smarter?

Let us help you get better insights into your marketplace so you can make more informed decisions.

Call us at 877.955.2537 or click the button below.

Let’s Talk

We are happy to provide you with a free consultation and talk about your business goals.