IPA SERVICES
CONTRACTING
Connexus Solutions can negotiate health plan contracts across all product lines including Commercial, Medi-Cal, Medicare and PPO/EPO. Our contracting department can develop various contract models that support specialist, ancillary and hospital based physician groups. Connexus Solutions can perform analytical studies on existing health plan risk arrangement to formulate a business plan that is conducive to fiscal discipline and measurable market growth.
HEALTH PLAN CORRECTIVE ACTION PLAN
Connexus advisors have comprehensive background in working with health plan auditors in addressing non-compliance areas related to Claims, Medical Management and Credentialing. We have developed audit tools that are specific to each delegation function and are measured against industry benchmarks such as timeliness, turn-around-time, denial rate, production standards and other management dashboard indicators. Connexus can incorporate a health plan corrective action plan that is tailored for the risk bearing organization by adopting industry "best-practices" to achieve compliance on policy & procedure while maintaining accuracy and production standards with the delegated functions such as claims adjudication and authorization processing.
POLICIES AND PROCEDURES
Connexus Solutions provides Managed Care Programs - Policies and Procedures for risk bearing organizations that have health plan delegation for Claims, Medical Management and Credentialing Departments. Our team can customize the Managed Care Programs based upon the product line such as Commercial, Medi-Cal and Medicare. The Managed Care Programs are developed in conjunction with the industry regulatory guidelines from CMS, DMHC, DHCS and NCQA. Connexus can also update existing Managed Care Programs for the risk bearing organization who are non-compliant with the health plan audit and will require substantial revision to their technical policy and procedure.
INFORMATION TECHNOLOGY
Connexus has experience working with various Managed Care Systems Technology platforms that can automate managed care infrastructure to capture fundamental critical elements such as claims/authorization processing, eligibility/encounter data submission and standard health plan compliance reports such as HEDIS. In addition, our team can build interfaces between managed care platforms and other existing EMR systems. Connexus Solutions flexibility in Information Technology allows us to work collaboratively with your existing IT infrastructure to ensure that we have a seamless integration with minimal down time.