Managed Care that Works for Everyone
Prime Network Provider Spotlight
DELRAY MEDICAL CENTER

DELRAY BEACH, FL
   About Us
Products and Services Evolutions offers a comprehensive selection of Preferred Provider Networks that complement increasingly innovative benefit designs with the greatest selection of participating providers, at the most preferred discount rates.

Florida based Preferred Provider Network Solutions
Prime Network - Our Carrier-level Provider Network offered throughout Florida
Prime Plus Network – A complementary Provider Network that expands the Prime Network for National Coverage

National Preferred Provider Network Solutions
Select Network – Our highly-rated National Preferred Provider Network
Select Plus Network (a.k.a., Advantage or Preferred Network) – A complementary multi-network solution offering extended national provider coverage

National Cost Containment and Workers’ Comp Solutions
Choice Network – Medical Cost Management Network
SelectWC Network – National Workers’ Comp Network


Claims Management and Repricing Services
TRX – The EVOLUTIONS Transaction Repricing & eXchange service architecture.
TRXpass – Web Repricing.
TRXchex – Web Imaging & Claims Status.
TRXport - Electronic Data Interchange (EDI) Repricing.
Mail Room Services – For paper claim handling and repricing.

Learn more about the Products and Services offered by Evolutions by contacting our Sales & Marketing Department


Preferred Provider Network Solutions

Prime Network – Carrier-level Provider Network - Florida
The Prime Network offers extensive access to hospitals, physicians, and specialists located in Florida at highly competitive carrier-level discounts. Available by Metro Service Area(s) or MSA's, The Prime Network is rapidly growing throughout the State of Florida. Choose Prime and Prime Plus for your Florida based employee and association members.

Prime Plus Network – A Complementary National Preferred Provider Solution
The Prime Plus Network seamlessly extends the Prime Network to offer complementary PPO network coverage at over 3,500 acute-care hospitals, and 400,000 providers nationally.

Select Network – National Preferred Provider Network
The Select Network is one of the most highly-rated nationwide preferred provider (PPO) networks available, providing access to over 382,000 Physicians, 30,000 Ancillary Facilities, and over 3,500 Hospitals. Choose Select and Select Plus for your employees and associations living outside of Florida.

Select Plus Network (a.k.a., Advantage or Preferred) – National Extended Provider Solution
The Select Plus Network offers complementary expanded provider coverage for larger and more highly disbursed employer and association members. The Select Plus Network seamlessly extends the Select Network with additional access at over 500,000 Physicians, 33,000 Ancillary Facilities, and over 4,500 Hospitals.

Choice Network – Medical Cost Management Network & Services
The Choice Network offers additional provider discounts and large claim negotiation services for out of area claims. Through the Choice Network, Evolutions provides pre-negotiated rates at over 2,000 Hospitals, 200,000 Physicians and 3,000 Hospital and Ancillary facilities, including Surgery Centers, MRI Centers, Laboratories, Radiology, Urgent Care Clinics, Home Health, DME, Chiropractors, Physical Therapy, and Mental Health Providers. Choose the Choice Network or Evolutions large claim negotiation service for managing Out of Network claims.

SelectWC Network – National Workers’ Compensation Provider Network
The SelectWC Network is comprised of over 200,000 Physicians, Hospitals, and Ancillary facilities that have agreed to negotiated rates for treatment of work related injury. Through strategic partnerships Evolutions offers the SelectWC - Workers’ Compensation Network as an integrated solution with leading bill review companies.

Learn more about the Preferred Provider Network Solutions offered by Evolutions by contacting our Sales & Marketing Department

Claims Management and Repricing Services

Evolutions distinguishes itself among other preferred provider networks by combining superior service with a powerful technology platform for managing and accessing to our vast provider base and cost management solutions. Evolutions was one of the first PPO Networks to offer online claims repricing & claims status, OCR scanning, and EDI connectivity. We continue to lead the industry in innovative developments including the “Hurricane Flag” used to track primary, secondary, and tertiary ICD-9 codes that integrate directly with our Healthcare Management Solutions. Evolutions claims management and reporting systems are fully secure and HIPPA compliant.

TRX – Transaction Repricing & eXchange
The Evolutions PPO Network is powered by our highly customizable TRX (Transaction Repricing & eXchange) service architecture. TRX is a powerful open-architecture, claims management solution designed to integrate well with client specific claims flow requirements and leading claims adjudication systems such as RIMS, and ERISCO. Through the use of TRXpass, TRXchex, and TRXport, our clients benefit from having a highly automated and secure claims repricing, reporting, and transactional routing solution that’s well integrated with their business.

TRXpass – Web Repricing
Clients can access the full function of the TRX system and reprice claims via a secure web connection at www.ehsppo.com. TRXpass is an easy to use, claims repricing solution which provides instant repricing and EOR access on a per claim basis. Learn more about repricing HCFA and UB-92 claims on-line or request a demonstration by contacting Sales & Marketing Department.

TRXchex – Web Imaging & Claims Status
Along with TRXpass for web based repricing, clients can access a copy of the original claim images and Explanation of Repricing (EOR) using TRXchex, for immediate claims adjudication or for Customer Service related issues. Learn more about TRXchex and TRXpass or request a demonstration by contacting our Sales & Marketing Department.

TRXport - Electronic Data Interchange (EDI) Repricing
Based on our TRX open architecture claims management solution, Evolutions utilizes TRXport for secure transmission and receive claims data from our clients. Electronic Data Interface (EDI) is a standard transaction set (supporting both HCFA and UB-92 claims data), that allows clients to submit and receive batches of claims based on the X12 837/4010 claim transactions format. EDI based transactions are automatically matched with Evolutions provider network, processed by the TRX claims management system, and returned electronically in the ASC X12 837/4010 format. Learn more about TRXport by contacting our Sales & Marketing Department.

Mail Room Services – For paper claims handling & repricing
At the Evolutions Claims Processing Center we staff our own full-function mail handling facility to manage paper based claims. All paper claims are scanned and imaged using OCR/ICR technology, then fully validated for data integrity before submitting for automated repricing using TRX. Completed claims can be distributed with the Explanation of Repricing (EOR), in paper or returned in a standard or custom electronic format. Imaged claims and the EOR can be viewed over the web using TRXchex. Learn more about Mail Room Services by contacting our Sales & Marketing Department.

Learn more about the Claims Management and Repricing Services offered by Evolutions by contacting our Sales & Marketing Department.