Managed Care Contract & Consulting Services

○ Uncover a better understanding of current contracts and systems with a complete audit and identify              where profits can be increased.

○ This is the “royal” or “celebrity” treatment. It's peace of mind, support and guidance, a first class service,        where you can sit back and relax while we take care of all the details. Let us explain what that means…

 ○ The Red Carpet is combining all the solutions into one, with ongoing services in:              

         * Education                               * Contracting negotiations

         * Training                                  *Specialty reports

         * Audits                                      *Contract summaries &                                                                                                                                                              managed care plan set up

         * Consulting                              *Managed care system                                                                                                                                                                development tailored to facility

Red Carpet/Specialty Services

Combine all the services MIX Solutions offers with ongoing training, audits and consulting with The Red Carpet. 

How Will These Services Help Our Facility? 
​  
 ~ Here are some, but not all ways these services can help:

Contract Support

  • Uncover a better understanding of current contracts and systems with a complete audit.
  • Identify where profits can be increased.
  • Negotiating new contracts and re-negotiating old/outdated contracts, including document preparation and presentation through credentialing and submission to health plans. 
  • All communications and requests from health plan during credentialing phase are taken off the Skilled Nursing Facilities’ “plate,” leaving them time to do what they do best – taking care of patients.
  • Quarterly education and training on managed care topic of choice to give staff a broader understanding of the changing healthcare rules, regulations, and legislation.
  • Managed care systems implemented and staff trained on how to maintain them.


Education/Training Support

  • Training staff on HMO managed care best practices. 
  • Educate staff on all aspects of the changing healthcare industry as well as keeping up-to-date on all aspects of managed care through webinars and seminars at your location(s).


Case Management Training

* A Mix Solution’s expert Case Management specialist will visit your location(s) at a pre-determined amount of visits per    year to help implement and train your team in the following areas:

  • Training on each managed care contract with emphasis on understanding levels and exclusions.
  • Set up maintenance for payment and tracking systems.
  • Eligibility and benefit verification and attaining authorization.
  • Pharmacy medication/bill review to capture all contract exclusions. 
  • Manage case management role in each facility and be a part of the hiring process of the Case Manager.


Audits/Reporting

  • Check claims for accuracy and completion – on an as-needed basis.
  • Review case management charts to confirm correct levels and everything is being captured – 5 charts per month for the first 3 months and then on an as-needed basis after that.
  • Specialty reports with contract summaries and other unique or custom requests.


Consulting Services

  • LOA’s and negotiations.
  • Communications with health plans regarding claims/billing/managed care growth.
  • Education on current industry information.
  • Name changes to current contracts​.