About Us

We prefer to talk about how we can work with you and together reach your goals and objectives. However, a little “About Us” is in order so we can begin to create a lasting partnership.

Five Star Solutions with Five Star Plus Service

PNS works as a business extension for health plans and physician practices. Our administration and staff are seasoned professionals with vast experience in health care trends, business operations and practice management.

Five Star Standards

PNS sets itself apart with five star plus standards – going above and beyond government requirements, traditional ideas about alternative payment models, patient satisfaction and access to care.

Just as important, PNS’s team shares Five Star values:

We are committed to a higher level of detail in everything we do – that commitment guides all of the services that PNS offers.

Today, when every dollar has to work harder, so does PNS. As the ACA continues to change our Health Care system, PNS works diligently to find innovative ways to provide our partners (health plans and physician offices) quality-driven, cost-effective, business solutions to meet their needs and business objectives.

Five Star Plus Service

Health Plans

  • Attentive team of professionals eager to assist the Health Plan meet business objective
  • Clear understanding of the importance of quality care
  • Proactive team always looking at how PNS “could do the work for you”
  • PNS prides itself on being a service driven company – not only offering cost saving alternatives, but also a partnership; we all succeed together

Health Care Providers

  • Well educated, proactive and dedicated staff that supports our providers by offering effective and timely customer service experience
  • PNS is contracted with most major Health Plans in South Florida, offering our provider access to a significant number of patients as well as potential for new referral sources
  • PNS promotes entrepreneurship by supporting the independent physician practices
  • Our management team continuously looks for ways to promote our network and our network providers at no additional cost to our providers

Staff

  • Work environment that fosters innovative thinking
  • Inspire continual self-improvement
  • Promote teamwork
  • Offer professional growth opportunities

Five Star Values

  • Innovative healthcare delivery systems
  • Effective network management
  • Strict adherence to quality standards
  • Promotion of CMS’ specialty-specific best practice guidelines (Center for Medicaid and Medicare Services)
  • Robust informatics and reporting capabilities

Five Star Members

Over 600 specialty care providers/Over 1 million members

PNS has over 600 of the region’s best specialty care providers. We manage the specialty care of over 1 million members. We have the expertise, reach and participation numbers to contain costs, support healthy growth, streamline operations and embrace innovation.

Florida and Louisiana

In Florida and Louisiana we have established our place as leaders, innovators and experts in Specialty Network Management.

Managed Care Plans

We have developed strong partnerships and alliances with the largest regional health plans. AvMed, Humana, Magellan, WellCare, Florida Blue (Blue Cross & Blue Shield), and Coventry-Aetna Health Plans. PNS is also a trusted partner with the largest Medicare Advantage Health Plan in Louisiana, Peoples Health Network.

Five Star Leadership Team/Staff

Our team of accomplished and respected health care industry professionals sets the tone and standards for Provider Network Solutions (PNS). Our leaders consistently generate fresh ideas and approaches that add value to our Network Partners’ operations. We have over 30 years combined experience managing specialty networks and working with third-party payors throughout the United States. Our management team is strengthened by an exceptional Board of Directors. Our board members possess expert knowledge in every sector of the healthcare industry. In fact, they are frequently sought by managed care plans for their valued opinions, expertise and proven strategies on cost containment, risk mitigation and quality management. The PNS team also includes medical peer committees that work with our Network Providers to promptly process the authorization to ensure that appropriate care is given to the patient and that best patient outcome is obtained.

Five Star Management Philosophy

We believe that in order to sustain a viable business, we must lead with empathy and integrity, provide value to our customers by anticipating any possible issue and creating a resolution. We empower our staff to be innovative thinkers and encourage a team approach when solving issues. We embrace new technologies in support of our vision and stand behind our work at the end of the day.

Five Star Claims Processing Efficiency

PNS has brought together the medical and administrative expertise with IT systems that enable highly efficient electronic authorization and claims processing. Our system provides for electronic claims receipt via EDI, while closely adhering to all federal guidelines and regulations. Claims are processed rapidly and accuracy is paramount, resulting in an accurate, expedited payment processing. Our network providers appreciate getting paid promptly and that no claims are lost. They also value our network’s extensive reporting and customization capabilities, enabling them to monitor and run a well-managed operation.

A Five Star Patient-Centered Approach

PNS strongly believes in empowering the members of our health plan partners to make educated decisions when it comes to their health. Our network providers adhere to the CMS specialty-specific best practice guidelines (Center for Medicaid and Medicare Services) and use these guidelines to determine appropriate treatment, improve the delivery of care and enhance positive health outcomes. We encourage and support the Health Plan’s educational literature, promotional campaigns, initiatives and Disease Management Programs. Together, we all make a difference.

Five Star Corporate Structure

Provider Network Solutions, LLC (PNS) is the management company for our three affiliated specialty networks.

Specialty Networks:

Our company began servicing the South Florida market in 1998 and has now expanded to serve the State of Florida and Louisiana. Our corporate growth can be attributed to several factors, but none more important than our ability to scale our business model to service the growing needs of our health plan partners and network providers.

Our TPA

We are a licensed Third Party Administrator (TPA) which allows us the opportunity to manage multiple administrative processes in the healthcare business environment.

Our services include:

  • Eligibility verification
  • Claims adjudication and processing
  • Managing alternative payment models, fee for service and administrative contracts
  • HIPPA (Health Insurance Portability and Accountability Act) compliant informatics and security
  • Ability to provide customized reports to our health plan partnersand network providers

Our Medical and Quality Departments

Each of our provider specialty networks is clinically overseen by a chief medical director and an advisory board of specialty specific physicians. Our clinical guidelines are developed and continuously enhanced as a result of new scientific research and regulatory changes. 

Our quality initiatives are in line with CMS, and we work closely with our health plan partners and network providers to facilitate the collection of vital reporting data. We encourage our health plan partners and network providers to collaborate with our quality management department in an effort to develop specific instruments such as surveys, clinical databases and other measures, as needed to capture valuable informatics.