NETWORK BENEFITS

GET REAL HELP

Revenue Cycle Management

• 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.

FAST RESULTS

Utilization Management

• Real time encounter notification services to physician partners of Admit-Discharge-Transfer (ADT) for both inpatient and emergency department encounters.
• Complex Care Management strives for optimal health and quality outcomes for patients, consequently reducing medical costs and providing the highest quality of care in collaboration with members and primary care providers.
• Transition of Care program created to minimize fragmentation in care and maximize communication for patients with highest risk for readmission.
• Social Care Management which is committed to promoting social, emotional and behavioral stability in order to improve clinical outcomes and quality of life for the fragile and elderly population that require additional support through community outreach.

MEET THE STANDARDS

HEDIS Management

• Provide continuous communication and transparent data to providers to review HEDIS progress.
• Implement tracking tools to quantify progress on curing gaps.
• Meet standards to earn health plan dollars for Provider bonuses.

EFFICIENT TOOLS FOR YOU

Data Analytics

• 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 MLR reduction.