Sentinel Services
Our Sentinel solutions are designed to identify unique & effective cost containment, reduce waste, and maximize savings across the continuum of care.
Our Sentinel Services
Post-Acute Care Solutions
Prodigy’s PACparency Network offers the ability to meet injured worker’s catastrophic and complex care needs thru a nationwide best practice focused network.
100% transparency of provider reimbursement, savings retention and your total savings.
Accurate state fee schedule determinations for all bills and PAC provider types.
Medical Drug Rebates
Drives payer rebates not captured by traditional PBM for high expense/high acuity drugs delivered in acute and ambulatory healthcare settings.
Current rebate opportunities are available on 100+ medical drugs in 300+ formulations.
Prodigy’s expertise in acute/ambulatory care provider billing ensures all rebate eligible drugs are identified.
Specialty Bill Negotiations
Delivering medical spend savings below your best available discounts and fee schedule allowed charges.
Works alongside your existing bill review and other cost containment resources.
All results include no risk of fee dispute and are accepted by billing provider.
Meet your Sentinel Leader,
Stan Smith
Stan is the Senior Vice President of Prodigy Sentinel Services. Prior to joining Prodigy, Stan launched and directed the first workers’ compensation Post-Acute Care managed care network. Stan has over 25 years of experience in acute, ambulatory, and post-acute healthcare revenue cycle and operations management.
Stan holds numerous healthcare industry awards for quality assurance & operations management excellence.
PACparency Post Acute Care Solutions
Prodigy’s Payer partners receive the confidence of full savings transparency, the ability to meet injured workers’ complex medical PAC needs nationwide, and guaranteed savings below provider’s billed or fee schedule allowed charges. Prodigy’s PAC team partners with providers delivering workers’ comp best practice care.
High visibility potential to showcase Best Practices to industry leading workers’ comp Payors.
Customizable reimbursement methods will ensure fair funding balance with providers.
Workers’ Comp specific Best Practice metrics.
Provider QA/CQI transparency.
Medicare Compare performance data.
3rd Party Patient Satisfaction survey.
Accreditation pathway updating.
Medical Drug Rebates
Our Payer partners recieve the ability to benefit from revenue rebates for high expense/high acuity drugs dispensed in Institutional and Ambulatory Care settings. Prodigy’s unique PBM and Acute & Ambulatory Care operations expertise allow it to identify these drugs and execute rebate revenue streams for its Payors.
Full access to primary Software Developer for EDI buildout and integration.
Prodigy’s current rebate eligibility includes 139 different high expense drugs in 309 different formulations. Rebate eligibility can occur for one time treatment or ongoing chronic care drug regimens.
Prodigy and its Pharma rebate partner are actively working with manufacturers to identify new drug class approvals specific to workers’ compensation injury health states.
Acute & Ambulatory Care Solution
Speciality Bill Negotiations
Our business model allows Prodigy’s Payer partners the flexibility to fully explore cost-containment options before finalizing medical spend decisions and access to cost of care data during complex & high cost Acute and Ambulatory Care claims treatment.
Prodigy’s results reveal the full savings opportunity and its fees. Transparency without compromise.
Transparency & Pass-Through Pricing
Comprehensive Timing Options
Ability to explore multiple medical spend options prospectively, concurrently or retro/pre-payment.
Bill Deconstruction, Comparables Review, & Provider Cost of Care/Revenue Cycle Simulations drive Prodigy’s outcomes.
Effective Methods
Trusted Expertise
Decades long executive know-how blending healthcare provider-side revenue cycle, Payer bill review & complex claims management expertise.