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Humana - PFFS

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Abourezk, Ilyani, LPC

Abourezk, Ilyani, LPC
Network
Clinic/Facility/Location Name

Abourezk Counseling Servces, LLC

Provider Name
Abourezk, Ilyani, LPC
Specialty
Phone
605-863-2881
Address
2020 W. Omaha Street
Rapid City 57702

Abraham, Prema, MD

Abraham, Prema, MD
Network
Clinic/Facility/Location Name

Black Hills Regional Eye Institute, LLP

Provider Name
Abraham, Prema, MD
Specialty
Phone
605-341-2000
Address
2800 Third St.
Rapid City 57701

Abraham, Prema, MD

Abraham, Prema, MD
Network
Clinic/Facility/Location Name

Black Hills Regional Eye Surgery Center LLC

Provider Name
Abraham, Prema, MD
Specialty
Phone
605-341-2000
Address
2800 Third St.
Rapid City 57701

Addiction Recovery Center of the Black Hills

Addiction Recovery Center of the Black Hills
Network
Clinic/Facility/Location Name

Addiction Recovery Center of the Black Hills

Provider Name
Addiction Recovery Center of the Black Hills
Specialty
Phone
605-673-2844
Address
14 Mt. Rushmore Road, Suite C
Custer 57730

Addiction Recovery Center of the Black Hills

Addiction Recovery Center of the Black Hills
Network
Clinic/Facility/Location Name

Addiction Recovery Center of the Black Hills

Provider Name
Addiction Recovery Center of the Black Hills
Specialty
Phone
605-716-7841
Address
1520 Haines Avenue, Suite 6
Rapid City 57701

Addiction Recovery Center of the Black Hills

Addiction Recovery Center of the Black Hills
Network
Clinic/Facility/Location Name

Addiction Recovery Center of the Black Hills

Provider Name
Addiction Recovery Center of the Black Hills
Specialty
Phone
605-745-6300
Address
646 Jennings Avenue, Suite 2
Hot Springs 57747

Akason, Danielle, NP

Akason, Danielle, NP
Network
Clinic/Facility/Location Name

Oyate Health Center

Provider Name
Akason, Danielle, NP
Specialty
Phone
605-355-2350
Address
3200 Canyon Lake Drive
Rapid City 57701

Albers, Lauren E., CNP

Albers, Lauren E., CNP
Network
Clinic/Facility/Location Name

Colin E. Brown PLLC

Provider Name
Albers, Lauren E., CNP
Specialty
Phone
605-718-5123
Address
240 Minnesota St.
Rapid City 57701

Ali, Ferhina S., MD

Ali, Ferhina S., MD
Network
Clinic/Facility/Location Name

Black Hills Regional Eye Institute, LLP

Provider Name
Ali, Ferhina S., MD
Specialty
Phone
605-341-2000
Address
2800 Third St.
Rapid City 57701

Ali, Ferhina S., MD

Ali, Ferhina S., MD
Network
Clinic/Facility/Location Name

Black Hills Regional Eye Surgery Center LLC

Provider Name
Ali, Ferhina S., MD
Specialty
Phone
605-341-2000
Address
2800 Third St.
Rapid City 57701

Allen, Avery, DPT

Allen, Avery, DPT
Network
Clinic/Facility/Location Name

Pain & Movement Solutions

Provider Name
Allen, Avery, DPT
Specialty
Phone
605-723-0185
Address
1238 Main Street
Sturgis 57785-1541

Allen, Avery, DPT

Allen, Avery, DPT
Network
Clinic/Facility/Location Name

Pain & Movement Solutions

Provider Name
Allen, Avery, DPT
Specialty
Phone
605-723-0185
Address
511 National St. #101
Belle Fourche 57717

Allen, Avery, DPT

Allen, Avery, DPT
Network
Clinic/Facility/Location Name

Pain & Movement Solutions

Provider Name
Allen, Avery, DPT
Specialty
Phone
605-593-4471
Address
3064 Covington Street, Suite 104
Rapid City 57703

Allen, Richard B., MD

Allen, Richard B., MD
Network
Clinic/Facility/Location Name

West River Anesthesiology

Provider Name
Allen, Richard B., MD
Specialty
Phone
605-755-1000
Address
631 St. Anne Street, Suite 102
Rapid City 57701

Allmer, Derek M, OD

Allmer, Derek M, OD
Network
Clinic/Facility/Location Name

Oyate Health Center

Provider Name
Allmer, Derek M, OD
Specialty
Phone
605-355-2213
Address
3200 Canyon Lake Drive , Ste 1
Rapid City 57701

Almeida, Rebecca, OT

Almeida, Rebecca, OT
Network
Clinic/Facility/Location Name

Black Hills Pediatric Therapy, LLC

Provider Name
Almeida, Rebecca, OT
Specialty
Phone
605-222-7336
Address
505 Kansas City St. Ste 3
Rapid City 57701

Alonzo, Nicholas R., PA-C

Alonzo, Nicholas R., PA-C
Network
Clinic/Facility/Location Name

Black Hills Orthopedic & Spine Center, PC

Provider Name
Alonzo, Nicholas R., PA-C
Specialty
Phone
605-341-1414
Address
7220 Mt. Rushmore Rd.
Rapid City 57702

Altergott, Kristi, PT

Altergott, Kristi, PT
Network
Clinic/Facility/Location Name

Monument Health Belle Fourche Clinic

Provider Name
Altergott, Kristi, PT
Specialty
Phone
605-723-8970
Address
2200 13th Ave.
Belle Fourche 57717-2215

Anand, Oksana, MD

Anand, Oksana, MD
Network
Clinic/Facility/Location Name

Rapid City Medical Center

Provider Name
Anand, Oksana, MD
Specialty
Phone
605-342-3280
Address
2820 Mt. Rushmore Rd.
Rapid City 57701

Anders, Kari, PT

Anders, Kari, PT
Network
Clinic/Facility/Location Name

About You Physical Therapy

Provider Name
Anders, Kari, PT
Specialty
Phone
605-721-3307
Address
3808 Sheridan Lake Rd, Suite 100
Rapid City 57702
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Employer Services Offered Through Participation with Western Providers

Employers who opt for self-funding enjoy the following advantages:

• Claims Process and Administrative Services Flexibility
• Plan Cost and Utilization Control
• Improved Cash Flow
• Choice of Service Providers – can limit the size/composition of the panel
• Flexibility in Plan Design
• Elimination of Carrier Profit Margins
• Lower Operating Costs
• No Medical Loss Ratio Requirements
• Uniform Regulations through ERISA

Physician Membership

Physicians (MD and DO) are eligible for membership (ownership)

in Western Providers Physician Organization

  • Membership advantages include:
  • Vote in corporate business
  • Eligibility for Board membership
  • Favorable treatment in certain provider panels
  • Risk/Surplus profit opportunity for some health plans
  • Eligibility for membership is determined by the Board
  • Membership remains with the physician identified, and may be transferred with Board permission if the physician retires, dies or permanently leaves the service area

Western Providers, Inc.’s network serves leading health plans including Aetna, Corvel, Humana, and Monument Health. By joining the Western Providers network, you invest in the future of quality health care that meets the needs of your patients and your practice.

Revenue and Expenses

Western Providers, Inc. obtains its revenue from access fees paid by its clients, the health plans it serves. Expenses include administrative operating costs, insurance and legal fees.

Western Providers, Inc. pays the expenses related to our provider rate setting methodology, known as the “messenger model”, as part of its services for client health plans.
Western Providers Physician Organization is owned by its physician members. WPPO obtains its revenue from membership and contractor fees paid by the panel of providers, as well as fees it provides for certain consultative, risk management and administrative services. Its expenses include administrative operating costs, costs related to credentialing of providers, insurance and legal fees.
 

How We Are Managed

A governing board of 12 directors guides company policy.

The Board consists of...

  • 6 directors of Western Providers Physician Organization
  • 2 administrative officers of Monument Health, Inc.
  • 4 directors selected by Monument Health

A chief executive officer provides strategic planning and oversees operations of the company.

What We Do

Services include...

  • Credentialing, all clinical providers – NCQA Certified in Credentialing
  • Western Providers is delegated for provider credentialing for all clients (payers) – providers submit one credentialing application and Western Providers Credentialing Committee approval satisfies the credentialing requirements for all clients/payers
  • Monthly, on-going quality measures, reports and statistical analyses are used to monitor the quality of the entire Western Providers panel
  • Network Development, on a payer specific basis for
  • ERISA self-insured health plans
  • Insured health plans
  • Preferred Provider Organizations (PPO’s)
  • Web site: Payer specific provider networks
  • Pricing
  • Messenger model (fee-for-service)
  • Shared Savings model
  • Primary Care Capitation model
  • Compensation Models
  • Discounted fee for service
  • Relative Value Scale
  • Inpatient DRG’s
  • Shared Savings
  • Primary care risk model
  • Provider Education
  • Western Providers provides email alerts and updates from specific clients/payers as Western Providers is notified of client/payer process changes
  • Credentialing
  • Credentialing is conducted with the assistance of an independent credential verification organization that performs primary source documentation. Providers must undergo review and approval by the Western Providers Credentialing Committee. The credentialing/re-credentialing process is conducted in a non-discriminatory manner; credentialing decisions are not made on the basis of an applicant’s race, ethnic/national identity, gender, age, sexual orientation, or the type of procedure or patient (e.g., Medicaid) in which the practitioner specializes, but solely on the criteria referenced by this policy and associated procedures. Western Providers reserves the right to limit participation in the WPPO panel to specialties and number of practitioners needed to ensure an appropriate panel and to limit to practitioners willing to adhere to WPPO requirements.
  • Cost Management
  • Messenger Model – For employer self-funded health plans, the provider network is developed through a legally qualified “messenger model”, an independent pricing process designed to obtain competitive provider costs.
  • Risk-based products – For some health plans, both employer self-funded and insured, a Western Providers panel is developed using capitation or other financing approaches that provide incentives for physicians and hospitals to manage costs
  • Population Health Management