PNS Provides Creative Solutions for Today's Challenging Healthcare Market

Our mission is to work alongside your team to optimize the delivery of specialty healthcare, guided by advanced analytics and our NCQA Accredited UM Program while adhering to regulatory requirements and information systems security guidelines. PNS focuses on providing member access and improving clinical outcomes, as well as member and provider satisfaction.

Join the many health plans already benefiting from quality clinical outcomes and cost containment affording them operational efficiency and specialty risk management.

By the Numbers

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Years of Success
Trusted partner delivering its clients the benefit of over 20 years of industry experience with a proven track record of success!
NCQA-UM-Logo

Ensure that your members receive appropriate care and improved health outcomes by partnering with one of the only specialty networks that provide NCQA Accreditation in Utilization Management

As a full-service specialty care management company and Third-Party Administrator, PNS delivers maximum benefits to its partners through compliance to industry standards, physician-led managed networks, specialty trained staff, and robust business informatics.

Our Solutions

Delegated Services

Our team is here for you every step of the way. With years of experience and training, we are fully prepared to provide exceptional quality care.

Claims Processing

A fully licensed and integrated TPA system that handles Medicare, Medicaid, Healthy Kids, CMS T19 & T21 & Commercial line of business

Compliance

A strong focus on compliance oversight of all CMS Medicare, Medicaid and Health Plans requirements.

Network Development

Ensures all state and federal guidelines for member access, accessibility, and provider ratio count are met.

Provider Relations

Works in close partnership with health plan partners, providers, and the community’s needs to create personalized specialty care solutions for all members.

NCQA

Utilization Management

Ensures that the delivery of health care is appropriate, cost-effective, and of high quality under the NCQA Accredited guidelines.

Credentialing Intake

Although we are not delegated for credentialing, we align with your credentialing requirements and alleviate initiating the credentialing process for unqualified providers

Lines of Business

We service and support Medicare Advantage, Traditional Medicare and eligible Medicare members who belong to an ACO. 

We service and support the Medicaid Managed Care population across the State of Florida, including SMMC Specialty Plans.

We service and support the Florida Healthy Kids population across the State of Florida.

We service and support many of our health plan partners whom have Commercial products, such as, individual, employer and self-funded.

We service and support many of our health plan partners whom have Exchange / ACA / Marketplace products. 

Our Specialties

  • General Dermatology
  • Mohs and Dermatologic Surgery
  • Pediatric Dermatology
  • Sports Medicine
  • Hand Surgery
  • Pediatric Orthopedics
  • Spine Injuries
  • Foot and Ankle Orthopedics
  • Joint Replacement
  • Trauma Surgery
  • Musculoskeletal Disorders
  • General Orthopedics
  • Reconstruction Surgery
  • Anesthesiology
  • Neurology
  • Physiatry
  • Physical Medicine and Rehabilitation
  • Interventional Pain Medicine
  • Podiatric Orthopedics
  • Podiatric Primary Care
  • Podiatric Sports Medicine
  • Podiatric Surgery
  • Podopedriatics
  • Wound Care and Management

Stay Tuned…

Health Plan Partners

Cigna
Florida Community Care
Simply Healthcare
WellCare