RECENT PROJEcts

At Managed Care Partners we realize that each provider has unique, individual needs, and we strive to employ our talents to meet those needs. This often results in work product which does not fit nicely on any list of standard services. So, to give you a better idea of the very wide scope of tasks we have been called upon to do for our clients, we have briefly described some of them below:

• Drafted RFP for TPA services for hospital’s employee health plan and solicited proposals from TPAs.

• Computed impact on hospital revenues of fixed rates proposed by United and suggested appropriate counter offers.

• Evaluated payers’ position on Never Events and reported findings to client hospitals.

• For a PHO (Physician hospital organization), prepared physician practice fee analyzer to compare, on a weighted basis, various payers’ fees to the member practices’ charges and to Medicare.

• Corrected Cigna’s misinterpretation of its own contract to insure claims would be paid correctly going forward.

• Caused Indiana Medicaid to issue policy statement to Medicaid HMOs so that facility and professional fees of provider-based services would be paid correctly.

• Performed audit of claims paid to hospital and its employed physicians by Medicare Advantage plans.

• Provided information about Medicare Advantage plans to client organizations and conducted programs about Medicare Advantage for hospital staff and seniors.

• Drafted agreements and arranged for participation of providers in hospital’s employee health plan.

• For a hospital and its employed physicians with 30+ payer contracts, weeded out those that were not needed and made certain that the hospital and physicians were all contracted with the same payers.

• Arranged contract for hospital with payer that had previously declined to contract with that hospital.

• Developed and implemented a marketing plan targeting 60 of the largest employers in PHO’s service area.

• Drafted provider’s response to major employer’s direct contracting RFP.

• Prepared and participated in PHO’s presentation requesting local employer use PHO as its primary network.

• Surveyed employers in provider’s service area to determine what health plans/networks those employers are using; met with local insurance agents to determine the health plans/networks they expected to be placing business with in the coming year.

• Assisted in drafting advertisements and website content to let the public know the health plans and networks in which the provider participates.

• Coordinated managed care contracting for specialty physicians when they, almost overnight, became employees of the hospital.