Create Your Success
Recommendations that Managed Care Systems Group allows you to achieve both Clinical and Financial Success. We say this because our process will allow you to focus on Clinical outcomes with your patients, you will have peace of mind in trusting that your providers are current and active with all participating payers in order for him/her to meet those start dates. This allows you to drop claims faster meaning more revenue stream coming in and greatly reducing any claim denials.
The following items are included in our Credentialing/Payer Enrollment process.
✓ Credentialing/Payer Enrollment Services Agreement
✓ Credentialing/Recredentialing Policy and Criteria for Health Care Organizations/Facilities
✓ Ongoing Monitoring of Participating Providers
✓ Scheduled Audits
✓ Facility Credentialing
✓ Provider Credentialing Appeal Process policy
✓ Credentialing Confidentiality and Security
✓ Applications that require Committee review
✓ Quality Monitoring of Credentialing Information
✓ Credentialing/Re-Credentialing Criteria for Physicians
✓ Peer Review Plan
✓ Individuals and organizations that must meet standards for Credentialing
✓ Delegated Credentialing Policy/Contract Language
Managed Care Contracting and Revenue Recovery plays a key role in a company’s continued growth. Managed Care Systems Group understands the lifeline of your organization is keeping current with contract language and rates, which is where we will review, maintain and setup meetings with all payers in order to move forward maximizing your revenue.
Part of this process will include Revenue Recovery efforts focused on critical areas of high dollar claims, underpayments by insurance plan over the course of calendar year and finally identify claim denials as root cause of loss of revenue.
Managed Care Systems Group will have a positive financial impact within your organization or group while working with you to customize only the services for which you have a direct need. Your success is our success and we take great pride in making sure our clients are satisfied with the work provided.