Managed Care Management

The most intimidating part of practicing medicine these days can be dealing with managed care organizations. The CMC managed care team has extensive experience in contract negotiations to ensure the best rates and services are accessible to everyone from small independent practices to large medical groups. Our managed care services include:

Contract review and analysis
CMC’s staff will work with your staff to review proposed contracts from managed care organizations to ensure the language meets your exact requirements with access to the most up-to-date information on competitive rates available in your area. Analysis can include comparison of FFS rates and capitation rate analysis with recommendations.

Plan viability analysis
CMC will help you determine whether a particular plan is worth accepting or not, based on rates and contract guidelines.

Quality control
CMC can help craft survey questions and coordinate with research vendors to execute follow-up research to gauge patient satisfaction.

Credentialing
Obtaining participation with managed care organizations can be a long, grueling process if you don’t know what you’re doing. But in order to ensure that your patients have access under their health plans, every doctor needs to go through the credentialing process. CMC can help you wade through the bureaucracy.

CMC personnel are experienced guides through the application process for managed care participation, in addition to helping physicians or physician groups apply to government managed care, such as Medicare, Medicaid, and TRICARE. CMC also provides access to the CAQH online credentialing service for applying to major health plans.

In addition, our staff will confirm qualifying physicians have the proper medical license, DEA certification and malpractice insurance. As an added benefit, CMC will also provide manpower for data entry, upon request.