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1. Services
Overview
©2011 Supero Healthcare Solutions, LLC. All rights reserved.

2. Services Overview
The core services offered by Supero Healthcare Solutions:
 Provider Enrollment
 Credentialing and Privileging
 Payor Contract Strategy and Negotiation
 Payor Contract Analysis and Modeling
 Payor Contract and Credentialing Maintenance
 Payor Contract Compliance (Contract Underpayment Recovery)
©2011 Supero Healthcare Solutions, LLC. All rights reserved.

3. Provider Enrollment Services
Provider Enrollment Services include, but are not limited to:
 “All Purpose” managed care representative for provider with commercial and government payors
 Commercial insurance enrollment
 Medicare enrollment (Individual and Group numbers/ Reassignment)
 Medicaid enrollment
 Other Government sponsored plan enrollment
 NPI registration (Type I and Type II)
 CAQH registration
 Secure market competitive contracts within the given market
 Provide complete contract and fee schedule analysis
 Rate and language negotiation
 Provide final fee schedule to billing department or billing company
 Complete all necessary credentialing requirements for each payor and follow through to completion
 Follow all payor contracts through to contract load date and provide copy of fully executed contract
 TIN Changes
 PECOS Enrollment
 Add new providers to existing TIN
©2011 Supero Healthcare Solutions, LLC. All rights reserved.

4. Credentialing and Privileging
Services
Credentialing services include, but are not limited to:
 Initial provider applications
 Re-credentialing applications
 Provider profiles
 Provider updates
 Medical Staff/ Facility appointment applications
 Medical Staff/ Facility Re-appointment applications
 License updates and renewals
 W-9s
 Confidential information reports
©2011 Supero Healthcare Solutions, LLC. All rights reserved.

5. Contract Strategy and Negotiation
Services
Contract Strategy and Negotiation Services include, but are not limited to:
 Serve as the provider’s advocate and liaison between the managed care organization and
management / billing department
 Develop market specific managed care contract strategy by payor to create ideal payor mix
 Negotiation and negotiation support
 Provide proposed language and financial modifications that can be used as counter proposals
 Development of template provider-specific “critical” contract terms and clauses that serve as the
basis for all negotiations
 Point out those contract provisions that cannot be administered without undue additional cost or
complexity
 Evaluate proposed contract language to ensure consistent and specific terms and eliminate
ambiguity
 Incorporate industry-wide benchmarks and contract terms to maximize reimbursement, improve
payment turnaround and minimize the potential for claim rejections
 Generate parameters of acceptable rates based on consideration of market environment/ philosophy
/strategy factors
 Address ongoing managed care issues, such as silent PPO activities and prompt pay expectations,
as well as emerging issues, including high deductible policies, discount cards and Medicare
Advantage products
©2011 Supero Healthcare Solutions, LLC. All rights reserved.

6. Payor Contract Analysis and
Modeling Services
Payor Contract Analysis and Modeling Services include, but not limited to:
 Contract modeling process that provides specific insight into the performance of an agreement by
service category, and allows the negotiating team to theorize “what if” with various proposals
 Model various contract scenarios against actual claim history to quantify financial impact
 Side by side comparison and contract performance reports for payors
 Develop proposed rates and rate structures
 Identify undesirable contracts and contract terms
 Contract Modeling to compare multiple fee schedule scenarios to determine if payor offer will increase
or decrease current contract
 Identify the impact of a contract change to each procedure code group using actual payment history
with each payor
 Analysis is created and stored for future reference and revisions
 Creation of payor report cards
 Measure the impact of payor rules
 Quantify the layers of contractual adjustments including fee schedule, pricing and clinical edit rules
 Promptly project revenue
 Identify the bottom line impact of contract changes to your organization
©2011 Supero Healthcare Solutions, LLC. All rights reserved.

7. Payor Contract Compliance Service
(Contract Underpayment Recovery)
Contract Compliance Service includes, but not limited to:
 Contract compliance service designed to measure payment accuracy and reduce the cost of dispute
resolution and denial recovery
 Provide the generation and population of data for dispute documentation required by the payor (e.g.,
appeal letter, payer form, claim and EOB)
 Dispute types include fee schedule underpayments, misuse of pricing or clinical edits and late
payment without interest appeals
 Provide edit matching against the payor's own repricing rules results in accurate identification of
underpayments and denials
 Provide tracking and recovery of appealed underpayments
 Determine if the plan is complying with both contractual and regulatory requirements
 Build and maintain payor specific pricing and clinical edit rules with minimal input required from the
user, models over 116 categories of contract parameters totaling more than 1 million rules per payor
for ever contract loaded
 Generate reports with critical information needed to monitor contract compliance and to assist in payor
renegotiations
 Provide intelligent tools to eliminate charges below fee schedule and coding errors
©2011 Supero Healthcare Solutions, LLC. All rights reserved.

8. Contract and Credentialing
Maintenance Services
Contract and Credentialing Maintenance Program includes, but not limited to:
 Evaluate new payer arrangements as they are presented to the organization
 Negotiate terms with those payers with whom the organization wishes to have a contract
 Calculate the financial impact of payer offers; suggest counteroffers
 Review the organization’s current managed care agreements; prepare and maintain a written
summary of each
 Compare reimbursement terms of your various contracts
 Make recommendations concerning changes in payer agreements
 Work with the organization and medical staff to establish direct contracts with local self-funded
employers
 Assist the organization’s staff in auditing payors’ remittances and compliance with contract terms
 Assist in resolving late or inaccurate payment problems
 Evaluate and negotiate risk contracts and bundled service arrangements
 Handle day-to-day communications with payers and renewal negotiations on existing contracts
 Conduct programs on managed care and related topics for staff, physicians, board members and the
community
 Monitor and report on expiring state licenses, DEA registration, board certification and professional
liability insurance
©2011 Supero Healthcare Solutions, LLC. All rights reserved.

9. Contact Us
Contact Us:
info@superohealth.com
512-308-6342
www.superohealth.com
©2011 Supero Healthcare Solutions, LLC. All rights reserved.