Safeguard Managed Care Contracts For your Providers, Hospitals, and Health Systems

In light of recent events regarding the Change Health Breach, safeguarding the #integrity of #managedcarecontracts is paramount.

1. Inventory your managed care contracts, treating Medicare Advantage plans akin to commercial ones for claim submission.

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1. Review claim submission requirements by plan and run revenue cycle reports to flag potential high-risk claims for non-payment.

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1. Understand paper claims submission processes within payers and ensure access to proprietary claim appeals submission processes.

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1. Verify consistency in payment posting functions, ensuring postings align with payer allowances.

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1. Aggregate allowables by payer and procedure to maintain consistency in pricing.

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1. Identify and address any inconsistencies in charge master rate schedules by code, provider, and location.

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1. Ensure 835-payment file posts accurately to allowed amounts and insurance payable to avoid disruptions in claim appeals and patient balances.

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Vigilance and proactive measures are key to navigating the aftermath of the breach. Stay informed, stay secure. #HealthcareRiskManagement #ManagedCare #FinancialIntegrity #TechnologySecurity #ChangeBreach #HealthcareLeadership

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