• We provide Specific Services that Aims to manage Medicare Members and Physicians for HMOs, MSOs and IPAs. Additionally, we can contract new physicians in such areas that our customers request

  • We work with your marketing department for Membership growth and retention strategies

  • We encourage doctors to work with your marketing department for welcome letters from PCP (including PCP logos and/or photos) to potential current and new members

  • We will collaborate with your marketing department for events such as community churches , Open House Mailings , Call center campaigns to newly enrolled, dis-enrolled or non-compliant members

  • We oversee medical records review to maximize MRA or medicare risk adjustmentWe review personally with the physicians on monthly medical management reports , such as;

    • HEDIS and Encounter audits/reconciliation

    • Claims reconciliation

    • Review Encounters (capitated claims)

    • Incentive Program (HRAs)

    • Reconciliation of refund requests

    • Facilitate credentialing paperwork for new and existing providers

    • ER Utilization

    • HEDIS

    • Hospital Census

    • Care Management

    • Rx Utilization

    • Specialist Utilization

    • Coordinate with health plans on all PCP related initiatives

    • Support member outreach initiatives to bridge gaps in non-compliant measures

    • Develop decision support tools that aide in the PCPs ability to capture all open measures on a patient visit

    • Reconcile claims data to PCP submitted claims and/or medical records

    • Collaborate with other Provider Networks to close open measures

    • Monthly chart audits

    • Membership Trends by PCP group

    • Growth

    • Disenrollment patterns

    • Reconfirm PCP roster

    • Provide recommendations for changes in PCP status, e.g. open panels, close panels and terminations