Center IPA’s claims department simplifies and make your claims processing prompt and efficient. All our staff are very experienced with Medicare, Medi-Cal, and Commercial regulatory requirements and time guidelines, simplifying and customizing claims processing. We provide flexible solutions that customize client payments based on each specific Health Plan contract, Provider Contract, member eligibility and member benefits.
Enrollment and Credentialing can become a hassle that could even interfere with the provision of quality health care. Center IPA offers a customized service that helps your organization work with all the major Health Plans in California. Our trained credentialing specialists complete the plan applications for your providers and work with the health plans after submission until participation is attained. If you choose to use our physician billing services as well, inclusion of provider numbers for claims submission is easily integrated.
Our Credentialing Department maintains provider files current with NCQA and Health Plan credentialing standards.
When a physician applies for membership with Center IPA, our credentialing staff performs verification of the following:
> Education – when, where, degrees, etc.
> Employment history and experience
> Hospital privileges
> Certification in various medical specialties
> Licenses to practice medicine
> Liability insurance coverage
> Disciplinary actions, if any, including malpractice claims
> Peer references – can other physicians who have worked closely with the applicant attest to his or her competence?
The Member Services/Eligibility department works with our contracted client’s health plans to provide the most up-to-date member information for our physicians, claims, and utilization management department.
Our Member Services department is committed to ensuring that we have the most up-to-date information on all of our members. This dedication is what makes the Member Services department thrive.
Knowing how important Provider Relations and Contracting is, our Center IPA’s provider relations department addresses and resolves concerns that providers have. Our team will assist you in complying with IPA policies and procedures, health plan audits, and regulatory changes.
Experienced Provider Relations staff are available to help you with claims submissions, authorization process, and other vital operational information while lunch is served.
Center IPA’s UM Department provides fast and accurate way to handle authorization requests and coordinate managed cared with the client’s Medical Director. Physician Profile referral statistics and hospital bed days reported monthly gives the IPA’s a current overview of their UM activities tied in with their financial status.
Our department allows for UM decisions to be made based only on appropriateness of care and necessity instead of financial rewards or incentives.
Our quality management team monitors quality of care and quality of services issues of the client group. Center IPA’s client committee oversees the functions of Utilization Management Department, and takes part in review process to ensure client and contracted providers abide by all NCQA, STATE, DHS, and HEDIS guidelines.