Claims Oversight

We utilize best practices to ensure timely and accurate payment to our network providers. We also provide a dedicated Claims Call Center so providers can speak with staff that has the ability to view the claims and to initiate corrections that same day. Our provider satisfaction survey showed that 90.6% of our contracted providers across all markets were satisfied with the support we provided regarding claims remittance.

Cenpatico® developed and implemented an innovative process that maintains standard claim processing timelines and avoids delays when any updates are needed to the system (what we call Risk Mitigation).

Our Prepayment Reviews provide overall system validation and allow us to ensure any non-standard payment agreements are met prior to payment. Prepayment Reviews occur with every check run.

Dashboard Reviews are generated and analyzed monthly by market. These dashboard reports are used to identify issues and can indicate trends at the specific provider level. We offer Targeted Provider Training to address provider-specific issues. For example, the Dashboard Review may indicate that a certain provider has submitted 40 claims and 30 were rejected because the claim forms were missing required information. Together, these interventions indicate best practice innovations.