Services        Overview©2011 Supero Healthcare Solutions, LLC. All rights reserved.
Services Overview   The core services offered by Supero Healthcare Solutions:       Provider Enrollment       Credential...
Provider Enrollment Services   Provider Enrollment Services include, but are not limited to:       “All Purpose” managed ...
Credentialing and Privileging                                                            Services   Credentialing services...
Contract Strategy and Negotiation                                                          Services   Contract Strategy an...
Payor Contract Analysis and                                                     Modeling Services   Payor Contract Analysi...
Payor Contract Compliance Service                                                 (Contract Underpayment Recovery)    Cont...
Contract and Credentialing                                                       Maintenance Services   Contract and Crede...
Contact Us                                                        Contact Us:                                            i...
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Supero Healthcare Solutions Service Overview

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Supero Healthcare Solutions Service Overview

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

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