Spring 2016
At Neighborhood, enhancing overall provider satisfaction is top of mind. It certainly was the case with recent updates to two of our departments. What was formerly known as Provider Engagement and Contracting is now called Provider Network Management (PNM). We feel that PNM more accurately describes the hard work the people in that department do every day.
Likewise, many of the PNM employees now have new job titles. Those who were once called “representatives” and “consultants” are now more appropriately titled Primary Care Network Administrators. These name changes come at an exciting time of growth for PNM. The department has increased its staffing levels and has been restructured in order to do a more efficient job of delivering high-quality provider management and satisfaction.
Similarly, the Claims department has restructured in order to accommodate the addition of two new teams: Service Recovery and Payment Integrity. The Service Recovery team will manage the most complex provider situations, with an eye towards uncovering issues and troubleshooting. The Payment Integrity team will seek to streamline the claims-payment processes by making sure internal and external policies are aligned and documented.
Finally, we have some other updates and reminders about the claims process:
- Claims that need to be corrected or voided can now be submitted electronically. There is no longer a need to submit these on paper. Providers should be sure to follow the appropriate EDI guidelines.
- Information-only claims that end in with a type of bill (TOB) ending in zero will now correctly process to pay $0 without having an adjustment needed. We will be correcting any claims that have been incorrectly paid by the end of April.
- Please be sure to use the correct Payor ID when submitting claims to avoid filing denials.
- Commercial Exchange products Payor ID is 96240
- Medicaid products Payor ID is 05047