Provider Data Management

Provider Contract Management
Apollo Health Street’s Provider Contract Management (PCM) team maintains provider contract terms in repricing and claims systems for preferred provider organizations and insurance companies. Our PCM team manages all types of network affiliation changes, fee schedule maintenance, and other contracting term maintenance for physicians, hospitals, and ancillary providers as well as currently processing approximately 100,000 provider contracts per month. We also assist our clients in provider data cleansing and provider data reconciliation. Using our proprietary technology and business processes we have helped clients create Single Record of Truth for provider information.

Key features and benefits of our partnership include:

• Complex contract and pricing term maintenance
• Demographic maintenance
  
• Facility, practitioner, and ancillary provider experience
  
• Network integration (merging PPO networks) and implementation of Single Record of Truth
  
• Improved quality resulting in more accurate claims payment and improved accuracy of provider directory information
  
• Improved productivity leading to significant cost savings

Provider Matching
Claims that fall out of the automated matching process can cause a significant bottleneck within claims re-pricing. Apollo’s Provider Matching services can accurately match these claims according to customer business rules and return them in a timely manner so that overall claims turn around times can be maintained. Apollo performs provider matching of over one million claims per month.

Key features and benefits of our partnership include:

• Tailored services to customer needs
  
• Meet strict Turn Around Time (TAT) requirement of four hours, six days a week
  
• Management of unpredictable volume levels that fluctuate hour-to-hour and day-to-day
  
• High levels of accuracy (>99%)

Provider Credentialing Support Services
Apollo’s Credentialing Support team assists in collecting, compiling, and verifying the information (Primary Source Verification) required within the credentialing process. Our team has experience in credentialing as well as recredentialing services. We are experienced in Primary Source Verification (PSV) of physicians, facilities and dentists. Apollo leverages proprietary software that smoothly integrates with our client’s credentialing application. Apollo’s proprietary software enables efficient management of credentialing process leading to high quality, quick turn-around-times and high productivity. Apollo has delivered a significant reduction in the per application cost.

Key features and benefits of our partnership include:

• Streamlined credentialing process by leveraging Apollo’s proprietary credentialing software
  
• Verification of information in accordance with your unique credentialing requirements
  
• Ability to verify providers on CAQH as well as those that are not registered with CAQH
  
• Trackiing and prompt follow-up on outstanding information
  
• Adherence to customer-specific business rules to accommodate any special credentialing needs
  
• NCQA guideline adherence
  
• Smooth integration of Apollo’s proprietary software with your credentialing application

Provider Data Cleansing & Verification (DCAV) Services
Apollo’s DCAV team serves preferred provider organization’s, insurance companies, and other health information specialty organizations. Recognizing the importance of accurate provider information and the challenges in maintaining up-to-date information, our professionals utilize a variety of tools to identify and correct crucial information. The Apollo team leverages proprietary application to manage the DCAV process. Apollo has integrated the US Postal Service’s address database into its proprietary software to ensure collection of valid addresses and to convert into standard address format. Apollo DCAV team has deployed sophisticated predictive dialers to ensure efficient data collection.

Key features and benefits of our partnership include:

• Web-based data searches
  
• Database comparisons
  
• Calling campaigns to reach out to providers and collect and verify information
  
• Propriety tools that assure the best possible productivity
  
• Stringent QA analysis that assures the highest quality output

Provider Recruitment Services
Provider Recruitment Services can be time consuming and can require extensive follow-up efforts. Apollo Health Street’s recruitment specialists can maximize the success of recruitment programs by focusing on this labor intensive process with highly-qualified professionals who can communicate efficiently and effectively with all types of providers.

Key features and benefits of our partnership include:

• Proprietary web application to streamline provider recruitment process
• Management visibility to status of each provider through the entire life cycle of recruitment
  
• Analysis of providers’ reasons to decline network membership
  
• Assistance with healthplan and PPO strategies to improve recruitment results
  
• Smooth integration of Apollo’s call based recruitment efforts with client’s onsite recruitment efforts

Fee Negotiation Support Services
Fee negotiations for out-of-network claims are a critical part of our healthcare system. Apollo’s Fee Negotiation Support Services work with your team to reach maximum efficiency and effectiveness in all negotiations. Our professionals collect the necessary information to ensure that the negotiation process is smooth and that customer negotiation specialists can maximize their results and achieve more discounts per day.

Our professionals handle all types of non-network outreaches to include physicians, physical therapy, DME, and other specialty services. We can prepare the claim for negotiation and also follow up on the required agreements, especially important for on-going medical services.