Negotiation and Communication with Insurers
- Negotiate terms of managed care contracts on behalf of its members.
- Inform members and their staff of any managed care contract developments and/or changes relating to contract language, policy and procedures, reimbursement etc.
- Provide assistance with problematic insurance claims.
- The Executive Director coordinates a quarterly “Operations Meeting” with various office and billing managers to address day to day issues and seek out resolution on behalf of our physician members.
Credentialing
- Assist physician offices with credentialing and recredentialing via CAQH.
- Assist and manage credentialing for new physicians entering a practice.
Office Support
- Provide educational seminars to physicians and their staffs.
- Assist practices with notifying managed care companies of a change of demographics such as address, corporation name and/or change of a TIN.
- Negotiate reduced fees with vendors and financial/legal/technical support personnel
- Help implement practice software such as EMR and PM systems
Marketing/Advertising
- Market/advertise the services of our members
Pay for Performance
Manage
- Pay for Performance arrangements with certain managed care organizations.
- Shared Savings arrangements with select managed care organizations.