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a h ar`e your independent heolthwm choice. 4. NaphCare will continue to be responsible for billing the responsible contract agency for off-site treatment. CLAIMS ADJUDICATION Our Claims Department has the latest technology available in the market today. This enables our staff to handle your claims in the most efficient manner. The accurate and rapid processing of claims is a fundamental part of keeping costs down, and it also maintains our positive relationships with community providers, hospitals, and specialists. We ensure timely payments, accurate evaluation of claims based on approved services, and payments on claims only for inmates that are eligible at the time of service. ✓ NaphCare's Claims Department adjudicates "clean claims' within an average of 48 hours. ✓ Average cost savings on re -priced claims are 60% off usual and customary charges. ✓ Prompt turnaround time with non - electronically received claims keyed within 24 hours. Our Director of the Claims Department, Cathy Sherbet, has over 20 years of experience in claims management, including 7 years with McKesson, where she managed a department that processed over 400,000 claims per year. Cathy currently manages NaphCare's claim's department of over 30 employees. Claims Processing System Our methods for processing claims and hospital/provider discounts focus on listening to clients' needs. We adhere to high standards of accountability and quality that set us apart from the competition. All claims are reviewed for accuracy and proper treatment, as well as correct coding and billing. Claims are adjudicated using the software system McKesson, Managed Care Optimization (MCO), specifically designed for the managed care industry. We pay claims promptly and accurately by applying all applicable payment rules. The provider's contract, fee schedules, negotiated rates, and terms and conditions are all loaded in the MCO system at the time of agreement, ensuring providers are paid according to agreement. The system does not allow for payment of a global rate and additional codes charged for the same service, known as bundling of codes. Through this system, the submitted claims are correctly analyzed for accuracy. This software also provides healthcare claim DRG calculation, APC assignment, Medicare/Medicaid reimbursement calculation, data editing, and validation to set specifications. MCO, linked with TechCare®, is the perfect combination to manage inmate eligibility and ensure that only claims on eligible inmates are paid. Information from the client's inmate management system goes through the EHR system to MCO. The integration of MCO and TechCare® also allows the flow of information obtained from healthcare claims back to TechCare®. The on-site clinical team will have real- time access to off-site provider information, which dramatically improves continuity of care. Claims Administration Our claims examiners work closely with your staff to support the SAJ. From claims processing to bill payment, our streamlined administrative services will provide you with valuable benefits. Each claim received by the claims department is reviewed for accuracy and adherence to community standards. Inmate Medical Services RFP No. 17-051 City of Santa Ana 81 25F-80