Managed Care Assistance for Physicians

Our experience has shown that within the physician office setting, the day-to-day administration/ supervision of the managed care process is handled inconsistently and ineffectively. Physicians often do not have the internal expertise, time and/or capabilities to effectively handle the managed care process, address contract issues and proactively deal with payors.

CampbellWilson offers the following services to address your managed care needs with respect to your commercial payors:

Initial Review

Dependent upon receipt of all applicable contracts, questionnaires and claims.

• Initial review of contract.
• Provide questionnaire to identify current and historical payment issues.
• Conduct sample audit to verify payment methodologies.
• Review fee schedules.
• Meet with management to discuss audit findings to determine next steps.

Ongoing Services

Dependent upon receipt of accurate 835/837 files.

• Day-to-day monitoring of payor contracts.
• Review of policy and procedure changes that impact contracts.
• Identification and tracking of systemic contract payment issues.
• Consideration of State law provisions affecting contracts.
• Assist in responding to payor audit requests and/or recoupment demands.
• Provide detailed reports showing payor volume, contract issues, payor payments, to assist in contract re-negotiations.
• Ongoing communication related to contract changes, termination dates and underpayment appeals performance.

Enforcement Actions

• Proactive efforts to resolve contractual issues.

For more information, contact us at 800.723.6492 to speak to one of our experienced consultants.

15770 North Dallas Parkway, Suite 500, Dallas, TX 75248 | 214.373.7077 | Toll Free: 800.723.6492