Managed Care Contracting
• Managed care contracting.
• Establish and maintain relationship with managed care plans in the marketplace.
• Engage with payers over payment disputes.
• Monitor the provider presence and information accuracy in managed care plans eligibility manuals in conjunction with credentialing of the provider.
• Provide managed care education for MedicalEdge providers as deemed necessary.
• Engage with regulatory authorities regarding health insurance statutes applicable to the provider and payments arising from the provider’s services.
• Managed care contract compliance.
• Monitor and analyze payments from health plans.
• Monitor rights under prompt pay legislation.
• Monitor health plans undisclosed claims payment practices.
• Evaluate and initiate, as deemed appropriate, complaints against health plans.