News

Provider Relations Changes Focus for Fall Meetings

About 60 network providers are receiving on-site, customized presentations from Midlands Choice provider relations staff this fall.  Pended claim rates for these providers range from 8 percent to 97 percent.  Our goal is to reduce pended claims to less than 5 percent. 

The presentations to providers with significant claim volume-hospital systems, large physician groups, multi-specialty clinics and ancillary providers-are in lieu of workshops traditionally scheduled for this time of the year.  In addition, Midlands Choice representatives are calling on PHOs in these same communities.

Based on research of providers' claim history, presentations include specific recommendations for increasing percentages of claims that can be repriced without rejection or manual intervention.  Depending on providers' needs, topics may include duplicate claims, missing or inaccurate provider, group or payer information, or missing National Provider Identifier (NPI) codes.  We are also reminding providers who haven't done so already to register for online access to claim tracking and employer/group lookup tools.

"Our goal is helping providers submit clean claims so that we can forward the majority to payers within one day," Greta Vaught, vice president of operations, said.  "The presentations so far have been very well received.  Providers are very appreciative of us bringing this information to them."