Network Benefits

GET REAL HELP

Our team of certified medical coders provide dedicated services to our physician partners.
Conduct Medical Risk Adjustment (MRA) Audits and Reviews to optimize MRA scoring.
Provide Physician education to Implement best practice strategies for clinical documentation.
Perform continuous analysis of encounter data to ensure proper submission and capture by Health Plans and CMS to ensure revenue maximization.

Collaborates with providers to support members with complex medical conditions to deliver optimal services, thereby reducing the risk of admissions.
Ensures a smooth transition for patients post-discharge by providing home health assessments in order to reduce the risk of readmission.
Real-time notification services to all physician’s admissions, discharges and emergency room visits.
Strives to improve clinical outcomes by collaborating with local and government agencies to promote social, emotional and psychological stability.

Enhance Medication Adherence strategies to provide at least a 90% of adherence rates needed for Part D Measures.
Optimize all billing and coding to include exclusion codes to reach 5 star Quality goals.
Provide necessary tools to exceed expectations in the Patient Experience surveys conducted by the plan
Train your staff and consolidate all reports received from the plan to better facilitate the understanding of HEDIS and necessary quality measures.

Access to robust management reports specific to membership, premium, MRA and MLR.
Generate actionable reporting tools to providers to demonstrate costs in a variety of meaningful ways.
Create specific measures to efficiently target utilization.
Transforming complex data into digestible insights.
Create actionable plans to tailor to provider’s specific needs.

Help manage your membership panel by monitoring enrollments and creating strategies to tackle disenrollments.
Create and support outreach campaigns to current members during AEP or as needed.
Serve as a liaison between patients and providers, ensuring that patients choose the best health plan that fits their needs.
Providing guidance, education, and resources to help patients with any additional help they may qualify for.

Utilize up-to-date AMA billing and coding guidelines to maximize commercial reimbursement.
Work closely with providers on medical records to enhance documentation techniques, ensuring highest evaluation and management level reporting.
Timely ERA/EOB processing to ensure denials and rejections are captured and corrected efficiently.
Analyze accounts receivables to identify payer reimbursement fluctuations in order to minimize profit losses.
Expedite revenue cycle at a lower cost to health care providers via EDI transactions such as electronic claim submissions, EFT (electronic fund transfer) and ERA (electronic remittance advice).