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Provider Readiness & Training

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Readiness Checklist for the Move to Managed Care

  • Billing Software and/or Billing Vendor can submit clean claims to various plans.
  • Billing staff knows the managed care plans in the region and have current commercial contracts or contacts within the managed care behavioral and physical health divisions.
  • Clinical staff is aware of medical necessity criteria and utilization review expectations.
  • The program has identified how it will communicate to plans utilization review, contract issues and billing.
  • Clinical program staff have conducted a review on current service delivery with a focus toward marketability:
    • Are services provided medically necessary?
    • What outcomes does the program currently have? How is the program working to improve patient outcomes?
    • Does the program focus on efficient use of resources? There will be a shift in focus from volume driven payment in a fee-for-service environment to value driven payment.
    • How is the program preparing?
    • Do you offer unique services, serve a difficult or unique population?
    • Are you able to engage and retain patients?