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