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Our Services
Sales
- Initial presentation of Center Care and other managed care products to interested groups
- Work with agents and third party administrators to promote Center Care
products
- Assist with open enrollment and renewals
- Coordination of health fairs
- Reinsurance relationship maintenance
Member Services
- Employee education
- Claims assistance
- Network information
- Member complaints' resolution and tracking
Provider Relations
- Network development
- Provider contracting (hospitals, physicians and ancillary providers)
- Provider education
- Maintenance of provider relationships within the network
- Provider complaint and problem resolution
Provider Credentialing
- Systematic selection, evaluation and monitoring of providers
(physicians, hospitals and ancillary providers)
- Rigorous program based on NCQA guidelines
- Peer evaluation by committee of local physician leaders
Claims Repricing
- Ensure timely turn around for claims being repriced
- Maintain up-to-date information on clients, participants, networks,
and providers
- Reprice claims using a fee schedule, percent to charge or per diem
rate
- Identify claims with possible problems prior to submission to TPA
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