MMMaintenance MatrixSDVOSB
Healthcare

Healthcare Risk Management

Specific services that manage Medicare members and physicians for HMOs, MSOs, and IPAs, with the reporting discipline that keeps risk adjustment and quality measures on track.

Clinical corridor in a healthcare facility
Member and physician management

Specific services aimed at managing Medicare members and physicians for HMOs, MSOs, and IPAs. We can also contract new physicians in the areas our customers request.

Growth and retention

We work with your marketing department on membership growth and retention strategies, and encourage doctors to support welcome letters from the PCP, including PCP logos and photos, to current and prospective members.

Community outreach

We collaborate with your marketing department on events such as community church programs, open house mailings, and call center campaigns to newly enrolled, dis-enrolled, or non-compliant members.

Medical records review

We oversee medical records review to maximize MRA, or Medicare risk adjustment, and review monthly medical management reports personally with each physician.

Monthly medical management reporting

What we review with your physicians each month

Audits and reconciliation
  • HEDIS and Encounter audits and reconciliation
  • Claims reconciliation
  • Review encounters (capitated claims)
  • Reconciliation of refund requests
  • Reconcile claims data to PCP submitted claims and medical records
  • Monthly chart audits
Utilization and care
  • ER utilization
  • HEDIS
  • Hospital census
  • Care management
  • Rx utilization
  • Specialist utilization
  • Incentive program (HRAs)
Provider network
  • Facilitate credentialing paperwork for new and existing providers
  • Coordinate with health plans on all PCP related initiatives
  • Collaborate with other provider networks to close open measures
  • Reconfirm PCP roster
  • Recommendations for changes in PCP status, such as open panels, closed panels, and terminations
Membership and gap closure
  • Support member outreach initiatives to bridge gaps in non-compliant measures
  • Develop decision support tools that aid the PCP in capturing all open measures at a patient visit
  • Membership trends by PCP group
  • Growth
  • Disenrollment patterns
For further enquiries call
(484) 840-3864

info@maintenancematrix.com · Fax 215-887-2916 · Philadelphia, PA

Send a message