12 Care Management Support Services Your Practice Needs Today

Two Facets of Care Management Support

Managing health plans involves multiple professionals working together to provide specific treatment for their patients. Care management, therefore, needs operational and administrative success to implement programs effectively.

To cater to these needs, two essential parts of healthcare technology serve distinct purposes in optimizing patient care: 

• Task management support, for one, primarily focuses on operations and staff work. These tools help you track progress and manage resources so you never miss crucial contacts when organizing treatment across multiple organizations. 

• On the other hand, care management support aids in implementing personalized care plans for individual patients. It includes various tools to assess patient needs, develop comprehensive care plans, and manage claims and contracts. 

Both support systems enhance care coordination and aid healthcare providers in delivering the best possible care strategies. 

Understanding each system's unique services and benefits reveals how these are essential support for each step of the patient journey.

6 Task Management Support Services

1. Membership Enrollment

Enrolling patients in a health plan is a tedious process. An automated system  helps digitize member enrollment, organize eligibility assessments, and store revenue or capitation files in the cloud. This way, you centralize reconciliation tasks and generate reports without the hassle of manual processing.

2. Encounter Processing

Encounter data is essential for quality transaction feedback. Digitally managing these data ensures timely submission of all requirements, improving network performance and strengthening relationships between the health plan and its providers.

3. Provider Services

Accurate coding and billing are crucial for ensuring that providers receive precise reimbursement fees. Uploading provider records and contract alignments into a single digital repository makes billing much more accessible.

 A streamlined approach helps you avoid payment errors and guarantee seamless transactions with contracted providers, promoting efficiency and accuracy in the reimbursement process.

4. Health Plan Management

An agile digital platform allows you to configure health plan agreements and reimbursement structures for carve-out network provider organizations. Following standardized procedures and protocols means reduced discrepancies or variations in handling tasks. 

This consistency in upstream and downstream arrangements helps maintain a well-structured and organized health plan management system.

Read More: Do Carved-Out Specialty Plans Contradict Value-Based Care?

5. Reporting

Using software to create timely utilization, authorization, and claims reports is game-changing, especially when it removes the hassle of compliance reviews with custom formatting for every generated file. These reports are crucial for health plan partners to monitor performance while complying with essential delegated processes.

6. Workflow Support

Customization is crucial for processing referrals, authorizations, or claims. Adapting technical support designed to build and maintain configurable rules helps you tweak systems to work for you. This feature allows care managers to make decisions promptly, enhancing overall performance.

6 Care Management Support Services

7. Credentialing

Care managers have to maintain updated comprehensive provider profiles. Having a service that stores all data and performs primary and secondary source verifications to keep the data accurate and up-to-date helps healthcare organizations stay compliant with necessary regulations and standards. 

Read More: Features to Look for in a Healthcare Credentialing Software

8. Referrals Processing

Employing a system that speeds up the referrals and ensures operations follow standard directives is a great plus! With improved referral processing support, efficiently manage utilization cycles based on approved medical criteria and streamline the authorization process according to your organization's guidelines. You guarantee that referrals are processed smoothly, following the appropriate protocols.

9. Claims Administration

Claim denials often stem from inaccurate information — like missing patient details, insufficient health plan coverage, and invalid CPT codes. By embracing an end-to-end claims processing support service, you gain a reliable solution to tackle these issues.

Stay confident with a digital repository for seamless and complete handling of claims data while ensuring error-free claims, from submission to payment, with automated processing features. 

10. Capitation

You can be smarter with finance models. Adopting a financial arm maximizes incentives and creates profitable payment mechanisms. 

Experience both process and tracking services with an augmented capitation system. The system efficiently manages outbound processed capitation payments and provides reconciled member reports to providers. 

Generating analysis and utilization patterns to detect network leakage is a plus, helping you optimize financial performance.

11. Contract Negotiation

When it comes to contract negotiation, tapping into the expertise of experienced executive teams is a smart maneuver for your organization. They specialize in reviewing contracts and structures involving all stakeholders within your network, such as plans, providers, specialists, facilities, and ancillary services. These teams work on your behalf to negotiate contracts that bring meaningful resolutions and positive impacts to your bottom line.

 12. Call Center Operations

Call center services are capable of efficiently handling all inbound inquiries. They route queries to the appropriate personnel and integrate them with relevant department structures, like claims and referrals, for faster call resolution and problem-solving. This ensures that your members receive excellent service. 

Do it All with MedVision!

Managing care can be challenging, but an intelligent way to enhance your health plans' effectiveness is by tapping into innovative care management support services to optimize your resources.

That's where MedVision comes in! Whether you're a private medical practitioner or a growing organization, MedVision's BPaaS (Business Process as a Service) offers a cutting-edge solution for your practice. It takes the burden off your shoulders, allowing you to stay on top of care plans and control operational costs effortlessly.

Let MedVision's BPaaS be your secret weapon in conquering care management challenges and propelling your organization toward success.

Explore How You Can Get the Support You Need!