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Managed Care and Contracting Services

Medical Associates has a single information system and billing system, with a centralized administrative function. This allows Medical Associates to contract as a large entity with managed care carriers, insurance plans, and vendors, ensuring that the best interests of the patients and physicians are served.

Contracting

  • Review of contract language, rates/plan procedures for new business
  • Preparation of contract summaries
  • Contract negotiations

Credentialing

  • Initial applications for physician participation with plan
  • Coordinate credentialing and recredentialing of applications for all managed plan participation
  • Transfer of tax IDs, termination and change letters

Operational

  • Troubleshoot roster enrollment - payment discrepancies with divisions and billing
  • Troubleshoot procedural discrepancies with divisions and billing
  • Facilitate orientations for divisions by newly contracted plans

Monitoring

  • Enter data from rosters onto tracking spreadsheets
  • Quarterly profit/loss statements
  • Year-end statistics on profitability
  • Tracking of quarterly bonuses by plan
  • Prepare lists to update provider directories

Special Projects and Research

  • Break-even cost analysis
  • PPM contract review
  • Coordination of merger, shareholder, and other employment contracts
  • Affiliations point person

The Medical Associates administrative staff has over ninety years of collective experience in leading health care teams...

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