National Provider Network (TPTN)
TheraMatrix Physical Therapy Network (TPTN) – Managed Care Program
TheraMatrix Physical Therapy Network is an outpatient physical therapy provider network and managed care program with proven superior quality of care and reduction of health care costs that can be implemented for group health and worker’s compensation programs, nationally.
The TheraMatrix Physical Therapy Network carve-out program has proven to save millions in health care dollars annually through a unique model that includes, but is not limited to, the following:
- proprietary utilization and care management processes and procedures
- the application of a modified fee schedule which applies a per visit cap
- increased access to a manageable network of certified, credentialed, providers
- identification of fraud, abuse and alternative/experimental treatments
- a fully inclusive administrative fee, and
- patient satisfaction surveys consistently rated in the 97th percentile
The following illustrates TPTN’s proven success through its historical performance:
1. Utilization and Care Management:
a. TPTN applies successful proprietary utilization management processes and procedures that follow industry acceptable guidelines as outlined by reputable organizations such as the American Physical Therapy Association (APTA) and the Centers for Medicare and Medicaid Services (CMS).
b. Our clients’ utilization experience prior to the implementation of the TPTN program averaged between 26-28 visits per episode of care. The TPTN program reduced the average visits per episode of care to 13.6; a 48% reduction in utilization without limiting medically necessary care.
c. Savings on the evaluation and treatment of multiple diagnoses per episode of care, which represents 10% of the population.
d. The TPTN program has identified and eliminated inappropriate utilization of alternative therapies considered experimental or not clinically proven.
e. The TPTN utilization review and management model allows us to identify and manage the utilization for members with chronic conditions that are not expected to improve with outpatient therapy.
2. Cost Containment:
a. Total net claim payments were 54% lower than outpatient physical therapy claims paid by their previous carrier.
b. Our clients realize annualized therapy cost savings of greater than $4.5 million net.
3. Manageable, Quality Provider Network:
a. Patient satisfaction is consistently rated in the 98th percentile.
b. Over 99% provider access rate to certified and credentialed outpatient therapy providers.
c. Our national network is capable of expanding to meet the geographic access needs of any potential clients.
4. Customer Service, Provider and Member Relations:
a. The TPTN carve-out model has achieved 100% compliance with all required customer service and call center performance metrics nationally.
b. Our program has successfully placed 100% of members requiring specialty care with individual care coordinators who ensure care is directed to an appropriate provider and setting.
c. Member appeals represent only 0.01% of the total visit activity.
Service Offering Summary
Network Development and Management
Utilization Review and Management
Prior Authorization of Services
Quality Improvement Program
Please contact us for more information about how we can help your organization.
Tel: 248-333-3335 or 800-545-3422
Employer Request Form (PDF)
TPTN Provider Newsletters:
TheraMatrix Physical Therapy Network (TPTN) Provider Directory
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