NAPHCARE, INC. (2) - 2017 - Laserfiche WebLink

Home Browse Search

<4 ci lay your Wepwdwf hea9hwm choim NaphCare assigns an authorization number to each off -site occurrence that includes a scenario detailing the approved services integrated with service classes and procedural codes. Only approved services are reimbursed. We review claims to determine that charges are not in excess of the appropriate Usual and Customary Charges. We also review claims for prior payment to prevent duplicate billing. In addition, we review for accuracy to include valid dates of service, CPT and ICD-9 codes, and bundling and unbundling of codes. Any claims that are not valid will be returned to the provider as a denial and a corrected claim will be resubmitted for payment. The following criteria will be used in these reviews: • Eligible Patients • Usual and Customary Charges • Prior Payment • Accuracy Services that support our clients' efforts to stay current and compliant in a dynamic environment include: • Optimize productivity for correctional facilities through automated essential operations • Identify correct payments for providers • Direct contracts with providers • Flexible managed care software that allows for a wide range of date -sensitive fee schedules associated with contracts, including integrated DRG and APC processing • Referral/authorization component to facilitate case management and utilization management • Eligibility, submission/receipt of electronic claim files, and HIPAA standards • Customer service • Facilitate daily transactions • Allow providers to look up a member's eligibility and check claim status • Provide clients a comprehensive, line -by-line bill audit and analysis, ensuring they are charged a reasonable amount for the appropriate services • Match facility and/or physician bills to itemized statements to identify errors and unbundling of services E. OFF -SITE PREFERRED PROVIDER NETWORK 1. NaphCare has recruited and will continue to develop a Preferred Provider Network to provide all covered medical treatment and services that cannot be provided on -site. A complete description of our network for the SAJ is provided within this section. 1. We have provided written letters of intent from providers willing to participate in the Preferred Network. We have included letters of intent from the following providers in the Appendix: • Prime Healthcare (includes Garden Grove Hospital Medical Center, Huntington Beach Hospital, and West Anaheim Medical Center) • KPC Healthcare, Inc. • Image Orthopedic Lab, Inc. • New Image Dentistry & Implants • Diagnostic Laboratories and Radiology • BioReference Inmate Medical Services RFP No. 17-051 City of Santa Ana 82