Services

Our services reflect our way of doing business: they're straightforward, efficient and effective. Our extensive industry knowledge coupled with experience developing leading technologies results in demonstrated cost savings and improved health outcomes for our client's practices.

We offer a flexible service model and can implement a solution as basic or complex as needed to meet your objectives. Our standard services include all the requisites to effectively manage your company's risk based agreement(s), enabling you to fix your administrative expenses and stay within your contracted budget parameters. Supplemental services further empower practices and patients, for better health outcomes and healthier balance sheets. Our implementaiton team will work closely with you to develop the best program to meet your organization's objectives.

Basic Contract Management Options

• Customer service: We'll respond to standard patient/provider inquiries regarding claims, referrals and credentialing as well as handle more involved troubleshooting and problem solving.
• Medical management: Maintaining network integrity is our top priority as we track utilization and oversee the referral process, including outpatient referral utilization and inpatient admissions.
• Electronic eligibility management: We upload and maintain group eligibility data from virtually any file format, eliminating the risks and delays of manual data entry, for time savings, error reduction and real-time reporting on member eligibility.
• Contract payment processing: We work with all payment models to meet your unique contractual obligations, including manual or electronic capitated or FFS payment processing.
• 837 claim processing, 835/ERA submissions and EFT payments: Accelerate the time to provider payment with electronic claim file uploads. Eliminate cumbersome and time consuming paper EOBs. We'll deliver payment funds directly into designated provider account, speeding time to payment and reducing the risk of check loss or fraud.
• Provider credentialing (non-primary source): We act as a clearinghouse for your provider information taking the credentialing burden from your shoulders. This includes gathering, storing and submitting your provider ceredentials to plans and government agenicies.

Extended Contract Management

• QCPortal™: Further automate and streamline your processes with this easy-to-use Internet-based tool offering electronic eligibility, claims, referral and service authorization information at your finger tips.
• MyCareView™ patient portal: Empower your patients with easy electronic access to their eligibility, claims, referral and service authorization information, as well as vital stats, lab results, immunizations and more.
• Cost reporting: Detailed comparison of expenses by specialty and between periods help you better manage your contract for an improved bottom line.
• Balance sheet and income statement compilation: Streamline accounting functions for even greater efficiency with our integrated accounting services.

Clinical Integration Tools & Support

• CICareView™ clinical integration tool: This easy-to-use Internet-based tool is added to the QCPortal™ and tracks major disease states and results by physician and plan, providing performance feedback to help improve patient health outcomes and achieve HEDIS incentives. The MyCareView™ Patient Portal can be incorporated as well allowing for additional patient monitoring and communication.
• EDI (EMR and HL7) support: Achieve quicker more accurate exchange of lab results and other data.
• Additional support: To achieve change, data and information must be combined with action. We offer the human know-how and support to turn knowledge into action and will work closely with you or your providers to achieve your objectives.

Care Management

• Physician Liaison/Patient Outreach staffing: Compliance and health outcomes improve with personalized coordination of care for patients with severe disease states.
• CMCareView™ care management tool: Internet-based and simple to use, this tool provides a single-source location for physician and care manager to view and track patients' health history, goals, progress and vital health data.