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OUR SERVICE

Utilization Management Policies And Procedures
  • Utilization Management Committee Meetings
  • Inpatient Telephonic Review, Case Management And Discharge Planning Performed By Licensed Nursing Personnel
  • Medical Referrals Processed In 48 Hours
  • Utilization Management Committee Meetings
  • Stop-Loss Tracking And Payment Recovery
  • Referrals To California Children Services
  • Denials, Modification And Appeals Process
  • Capitation tracking from Health Plans
  • Capitation tracking from Group to Primary Care Providers
  • Capitation Check Run and Distribution
Quality Management Policies And Procedures
  • Quality Management Committee Meetings
  • Clinical Practice Guidelines
  • Grievance And Appeals Process
  • Provider Satisfaction Surveys
  • Member Satisfaction Surveys
  • Access Studies
  • Coordination Of Quality Management Issues Between Departments
  • Claims Management Policies And Procedures
  • Claims Review And Analysis
  • Coordination Of Benefits
  • Claims Adjudication And Payment
  • Weekly, Biweekly Or Monthly Check Runs
  • Claims Audits
  • Claims Payment Reports
  • Credentialing Policies And Procedures
  • Credentialing Committee Meetings
  • Credentialing Audits And Payor Compliance
  • Primary Source Verification
  • Initial Appointments
  • Reappointments
  • Development Of Provider Roster
  • Eligibility tracking from Health Plans
  • Eligibility tracking from Group to Primary Care Providers
  • Electronic Import Of Eligibility Data
  • Electronic Transmission of Encounter Data to Payors
  • Telephonic And/Or On-Site Consulting Available From Senior Or Junior Staff Members On Hourly Or Monthly Arrangements
  • Guidance And Orientation On Managed Care Clinical And Administrative Standards Of Care
  • Abqaur Certified Medical Director
  • Licensed Nursing Personnel