 |
 |
  |
|
|
||
|
|||
|
 |
 |
|
|
The Claims Department has the ability to process high volumes of claims. The department staff prides itself on efficient and accurate service. Payment to the providers is usually within thirty (30) days (health plan standard is sixty days). The claims processor processes every claim with precision and speed. Our Claims Department has achieved full delegation by all contracted health plans to process all professional and hospital component of claims. Back to top Our Credentialing Department maintains IPA's and Medical
Group provider files current with NCQA and Health Plan credentialing standards.
We utilize the latest technology in tracking information to keep our provider
files constantly up-to-date. CHM uses a unique database system that allows
fast entry and profile reporting to the health plans. CHM has been delegated
by all contracted health plans to carry out the Credentialing Process. The Eligibility department works with our contracted health
plans to provide the most up-to-date members' information for our physicians,
claims, and utilization management department. CHM provides the physicians
a monthly E-List that is user friendly to track the PCP's members. PCP's
can take advantage of direct deposit of their capitation for immediate
access of funds. The Finance Department is responsible for the preparation
of the budget and financial forecasts for IPA's and Medical Group. The
department evaluates the profitability of each of the health plan's contracts,
its products, and assists the outside independent accounting firm in complying
with federal and state regulatory requirements. The Finance Department
also oversees the Claims, Eligibility and Accounting Departments. The Health Education Department offers a wide range of
health information topics that are continually disbursed in a brochure
format to meet our members' and providers' need. As a subdivision of CHM's
Quality Management Department, its goal is to promote a healthy lifestyle
and to offer preventive health education to our members. Our members receive
a list of preventive care schedule for both adults and pediatrics incorporated
in their authorization letter. The Marketing and Management staff has accumulated years
of experience in the healthcare industry. The group promotes a synergy
of innovative concepts and ideas that they believe will allow IPA's and
Medical Group to emerge at the forefront of the managed care competition
in California. This department designs, creates and manages advertisement
campaigns and promotional materials. With a strategic plan, Central Health
MSO, Inc. has developed an aggressive approach to outreach the communities. Health care is a service-driven industry. By providing
caring and nurturing services, a satisfied member will refer others to
join the IPAs. The member service staffs are thoroughly trained to handle
member issues courteously and expediently in order to uphold the standards
of our IPA, Health Plans, as well as each individual physician. We educate
the physician staff through ongoing in-service sessions to be member advocates,
which helps members understand how the system works best for them and
therefore keeps patient grievance at a minimum. Our Information Technology Department is responsible for
the flow of current and accurate information between CHM employees, providers,
members, and health plans so that decisions that effect tomorrow can be
made with confidence today. CHM utilizes advanced computer software to
help maintain detailed Provider database and to assist in various essential
operations. CHM has integrated sophisticated web-based interactive services,
which enables providers to check on the status of claims, preauthorization,
and eligibility in real time through internet technology. Providers can
also submit claims and preauthorization online. Provider Relations is an integral component in maintaining
the cohesiveness of the network. It is extremely important to keep lines
of communication open between the providers of health care and Management
Company. This department addresses and resolves all concerns of the providers;
in addition, they ensure that all network facilities are up to par with
health plan regulations. CHM offers monthly group In-Services during lunch
hours to accomodate the busy schedules of our providers. In-Services are
conducted at two locations at Garfield Medical Center or CHM Covina office.
Experienced Provider Relations representative provides step-by-step explanation
on claims submission, authorization process, and other vital operational
information while lunch is served. CHM employs it's own in-house UM Department in order to
expedite requests for authorizations and to keep referrals within our
contracted network. Physician Profile referral statistics and hospital
beddays reported monthly gives the IPA's a current overview of their UM
activities tied in with their financial status. The Case Manager plays
an important role in the monitoring, tracking, and implementation of the
utilization and quality of patient care process. More importantly, Case
Management carefully monitors patients' status on a daily basis. CHM has
Hospitalists to assist PCPs in inpatient admission, which further enhances
the quality of care to our members. QUALITY MANAGEMENT & RISK MANAGEMENT The Quality Management Department oversees all of
the quality of care, and quality of service issues of the IPAs. The QM
staff, in conjunction with the QM Committee, directly oversees the functions
of the Utilization Management, Risk Management, and ongoing provider and
member health education. Our trained team also takes an active part in
site reviews and in keeping IPA's and our provider offices in compliance.
The QM Department meets all NCQA, STATE, DHS, and HEDIS guidelines in
monitoring the quality of services of our providers to the members.
|
||||||||||||||||||||||
WEB-SERVICES
LOG IN | CENTRAL
HEALTH MSO | CONTACT
US |  HOME |
