Our Operational Scope
We specialize in hands on managed and value based care.
We support day to day operations of the IPA and physician network. This includes regular interaction with physicians, their office staff, IPA leadership and contracted health plans. We provide the infrastructure and teams necessary to operate compliant operations while achieving care and business goals. We formalizing and tuning business and healthcare workflows with defined and automated processes.
Scope of services include:
- Claims Processing
- Financial Management
- Provider Contracting, Credentialing and Relations
- Patient and Provider Engagement
- Regulatory and Health Plan compliance
- Encounter Data and Quality Reporting and Submission
- Quality Reporting and Risk Adjustment
- Performance Reporting and Analytics
Claims Processing
IPA Providers may submit claims to MHM Health through the following Hard Copy, Electronic, and Web Portal. MHM Health remote access allows providers to review the status and history of their claims and payment with quick and easy access.
MHM Health claims department provides efficient and prompt claims processing services for our contracted IPA’s, Managed Hospitals and provides claims adjudication in contract agreements. MHM Health is able to specifically customize IPA payments based on Health Plan contracts, provider contracts, as well as member eligibility and member benefits.
Our state-of-the-art claim system is able to log, adjudicate and pay claims. Our claims system automates most of the processing to allow greater accuracy and faster claim turnaround time.
Our systems are able to read the information and automatically load it into our claims system. MHM Health has the capability to receive claims electronically utilizing healthcare standard EDI electronic formats.
Financial Management
Maximize revenues through detailed pay for performance, quality, and risk adjustment score tracking. Accurate capitation and encounter data submission
Manage capitation payment and reconciliation, financial reporting to health plans and regulators, and encounter data submissions.
Financial and investment analysis, operational/capital budget preparation, and profit and loss analysis by line of business with improvement recommendations.
Provider Contracting Credentialing and Relations
Provider Contracting is an integral component in maintaining the IPA network cohesiveness. We utilize an innovative database that allows rapid credentialing and updating for profile reporting to contracted health plans. Ongoing Provider Relations is critical for Provider satisfaction as well as maintaining provider performance and compliance.
Member Service Eligibility
Healthcare is a service-driven industry. The Member Services/Eligibility team works IPA contracted health plans to provide the most up-to-date member information for our physicians, claims, and utilization management department. Our member services staff are thoroughly trained to address member issues courteously and expediently in order to uphold the standard of our IPA’s, Health Plans, as well as each individual physician. MHM Health has a sophisticated Healthcare CRM and Unified Contact Center that tracks and trends member calls, and campaign performance.
Provider & Member Outreach and Engagement
Our provider outreach team provides ongoing education Health and Wellness products to our contracted providers in accordance with Health Plan and Federal regulations. Our team prepares and implements provider and member outreach campaigns in close cooperation with IPA priorities.
The team develops strategic plans through various media and collaborates with partners in the local health care community. The team develops tactical plans to support key initiatives. An example of campaign execution for membership expansion our teams evaluate and analyze the potential for patient conversion and new member enrollment together with provider offices. We then handle the coordination of all players involved in membership enrollment in a fully compliant approach. This is one type of initiative.
- IPA membership growth
- Member welcome, education and customer service
- Unified patient satisfaction communication
- Physician and member Wellness visit coordination
- Physician Office training and development