Health Plan Information

CLAIMS PROCESSING AND PAYMENT

As your Claims Administration Partner, our primary responsibility is to pay members’ health claims accurately and on time, in accordance with your Plan's provisions and provider contracts. As your Partner in Health, our larger goal is to improve the health of your Plan’s members and the quality of care they receive, while delivering bottom-line cost savings and added value to you, our customer.

CORPORATE HEALTH & WELLNESS SERVICES

Healthier employees bring increased energy, stamina and a positive attitude to the workplace, while needing less costly medical care. St. John’s Wellness programs are designed to help each individual reach his or her optimal state of health, through education and promotion of healthy lifestyles. Our wide range of preventive wellness services includes:

DIRECT CONTRACTS FOR ST. JOHN’S PPO NETWORK

Many of the area’s largest employers contract directly with St. John’s Health Plans. We are proud to serve our neighbors at Bass Pro Shops/Tracker Marine, Paul Mueller Company, the City of Springfield, City Utilities, Springfield Public Schools, Missouri State University, and more than 20 others.

EMPLOYER PARTNERSHIP PROGRAM

Employer partners receive information and tools needed to have as much control of healthcare costs as possible. The program is customized to meet your unique subset of employees, not a population who may or may not be relevant to your workplace. Click here to learn more!

MEDICAL MANAGEMENT SERVICES

Case Management
Data Management
Demand Management
Disease Management
Quality / Safety
Utilization Management & Review
PremierPP+ Precertification Guide
Premier Prior Authorization & Precertification Worksheet
Premier Plus Referral Form
Premier-GE Referral Form
Care Management Referral Form
Synagis medical necessity form

OCCUPATIONAL MEDICINE/WORKERS’ COMP PARTNERSHIP

Under the direction of a board-certified Occupational Medicine physician, our Corporate Health Services team can help you reduce the incidence of job-related injuries and illnesses at your company.

PLAN CONSULTING & IMPLEMENTATION

Our expert team consults on Plan benefits and features, designs and sets up customized Management Information Systems, including entry of covered benefits and reimbursement amounts and other Plan provisions. We coordinate preferred provider network services, including physician credentialing, compensation and reimbursement arrangements, and fee negotiations for non-PPO providers and assist with development, design, printing and distribution of Plan documents.

PRESCRIPTION PLAN PARTNERSHIP

St. John’s offers the area’s most comprehensive Prescription Drug plan, including:  more than 50,000 PCS network pharmacies, dedicated Pharmacy Benefit Management staff, fast claims processing and payment  and a formulary designed and managed by practicing physicians