Provider Updates

Summer 2024

Thanks for playing an important role in serving our employer-members. Here are the latest updates from The Alliance that may interest you.

Membership Numbers 
The Alliance consists of more than  118,000 lives from over  425 employers across the Midwest. The Alliance networks include over 39,000 providers.

Meet Sheryl Kealy:

The Alliance’s Credentialing Coordinator

Sheryl has four years of credentialing experience with a health system prior to joining The Alliance. She is currently building relationships and working cooperatively with our provider groups as we build our internal credentialing program.

Having accurate and up-to-date provider data is essential. So, in parallel with building our internal credentialing program, Sheryl is assisting with an ongoing directory verification project to ensure that The Alliance has the most up-to-date information for our contracted providers.

If she hasn’t already, Sheryl may reach out to you to verify current provider records.

Leapfrog 2024 Hospital Safety Grades

The Leapfrog Group released the Spring 2024 Hospital Safety Grades. This allows users to search for and compare hospital ratings so they can understand safety across different facilities.

We have integrated the 2024 Hospital Safety Grades into our Find a Doctor tool to help our employer-members' employees and covered family members make more informed decisions about their healthcare.

Congratulations to those in The Alliance’s network that worked diligently to improve their scores in 2024. Special recognition goes to: ProHealth, Monroe Clinic, Aspirus, Marshfield and Hospital Sisters Health System (HSHS).

Additionally, we are proud to acknowledge hospitals within our network that have the highest scores. Congratulations to: Monroe Clinic Hospital, ProHealth, Beloit Memorial Hospital.

Learn More

Hands-On Healthcare Data Analytics Workshops

Our employer-members have been expressing a strong interest in better understanding their healthcare data so they can make informed decisions about their health benefit plans.

In response, Melina Kambitsi, Ph.D., Sr Vice President, Business Development & Strategic Marketing and Ryan Peterson, Director of Analytics at The Alliance held data analytics workshops in Eau Claire, Wausau, and La Crosse to help employers use their data to improve their benefit plans, remove guesswork, and identify and mitigate risk for their organizations.

You can learn more about these workshops on the event page.

Third-Party Administrators (TPAs)

Below is a list of TPAs The Alliance’s employer-members utilize.

Key Points:

All claims should be sent to The Alliance for processing.
The top 5 TPAs account for 80% of The Alliance’s claim volume (these are highlighted below).
The TPAs below are listed in alphabetical order. The five most utilized TPAs are highlighted.
Some TPAs may have names suggesting a connection to a “health plan.” However, these organizations are used only for their third-party claims administrative services. They do not have access to The Alliance contracts or the employer-members' information. These TPAs are identified with an asterisk (*) below.

TPA List

90 Degree Benefits - EBSO	*Dean TPA	Meritain Health fka CBSA
Aither Health LLC	Exemplar Health Benefits Administrator	Northern IL Health Plan
Allegiance Benefit Plan Management	Flume Health	Prairie States
Allied Benefit Systems	Group Administrators, Ltd.	Preferred Health Choices
*Auxiant/WPS	HealthEZ	Professional Benefit Admin
Benefit Admin Systems	Insurance Administrators of America	Regional Care, Inc.
Benefit Plan Administrators	Insurance Program Managers Group (IPMG)	Security Admin Services
Blackhawk	Kempton Group Administrators	SISCO
CIGNA Healthcare Tennessee	Lucent Health	UMR/UHC
Consociate Health	MedBen	Wellfleet

2025 Healthcare Transformation Awards
Do you know someone that is driving innovative change in healthcare?
Nominate them for a Healthcare Transformation Award.

How do I submit a nomination?
Just fill out the submission form by November 1, 2024 and we’ll contact the nominees. Recipients will be awarded live at our Spring Symposium on April 23, 2025.

Who is eligible?
Any person or business that’s moving healthcare forward in a big way. Potential recipients include employers, providers, pharmacy benefit managers, third-party administrators, brokers, and more. You can even nominate yourself!

What are the requirements?

Nominees must move healthcare forward in a way that aligns with one (or all) of the four core drivers of High-Value Healthcare:

Transparency: You can’t manage what you can’t measure. Improving price transparency and/or implementing a better way to measure healthcare quality.
Payment Reform: Creating a program that rewards value-based care (cost-effective, high-quality care) over volume of care (fee-for-service).
Provider Network Design: Customizing your provider network to give your employees more high-value health care options while reducing their costs.
Benefit Plan Design: Using incentives to drive your employees to seek care from high-value providers and utilize primary care.

Submit a Nomination