The Alliance's progressive provider contracting methodologies are designed to help our members save on health care costs now and protect them against excessive increases in the future. In doing so, we apply various contracting methodologies to achieve an overall 27.3% health care cost savings to our employers. When an employer joins The Alliance, our membership agreement requires the employer to honor The Alliance's reprice amount as the true allowable for services received by their plan participants.
 
Our provider contracts also require that payors base payments on The Alliance repriced amounts. Alliance providers are not required to honor additional cutbacks to Alliance repricing by TPAs or reinsurers, and the patient may be billed for any amounts not paid by the plan, up to the total reprice amount.  
 
Examples of inappropriate cutbacks reported to us by providers include TPA reductions for multiple procedures, assistant-at-surgery and anesthesia claims. We apply all applicable reductions when the claim is repriced, and the absence of a modifier such as -51 does not indicate that multiple procedure logic has not been applied by The Alliance.
 
Where appropriate, modifier adjustments are applied according to the table below. Our adjustment factor is based on industry standards and contracts require providers to accept the adjustments we apply.

• A free, confidential health risk screening, conducted by a registered nurse. The nurse provides coaching on what to be aware of during pregnancy and if a pregnancy may be high risk. 
• General self-care information to promote good health during pregnancy.
• Information about other resources. 
• A free copy of What to Expect When You're Expecting, What to Expect-The First Year, or What to Expect the Toddler Years. 

For more information, visit the BabyLove Toolkit.

• Web content
• Ability for participants to self-report biometrics when filling out the health risk assessment (HRA) form.
• Availability of coach to come onsite to introduce themselves to participants before telephonic coaching begins
• "Health Solutions identifies the three largest health issues with the company and helps coordinate programs on the three largest risk factors."
• Ability to offer a paper HRA
• Availability to come onsite to address employee concerns with privacy.
• Very responsive and adaptable to organizations needs.