Provider Benefits
USPASS positions itself as a valuable ally for skilled nursing facilities, recognizing the complexities and administrative burdens they face in navigating the healthcare landscape. With over 25 years of experience and a deep understanding of the demands placed on providers, USPASS offers support in several critical areas, allowing facilities to focus more on delivering quality patient care.
How We Support Providers
Contracting: Advocacy and Streamlined Negotiations
USPASS understands that negotiating contracts with Managed Care Organizations (MCOs) – including Managed Medicaid, Medicare HMOs, and commercial payors – can be a time-consuming and often challenging process for individual facilities. USPASS alleviates this burden by:
- Acting as a Collective Voice: Leveraging its established relationships and the collective strength of its network, USPASS advocates on behalf of its member facilities during contract negotiations. This can lead to more favorable terms and rates than an individual facility might be able to secure on its own.
- Simplifying the Negotiation Process: USPASS often handles the initial outreach, proposal submissions, and negotiation discussions with MCOs, shielding facilities from the direct back-and-forth and administrative overhead.
- Keeping Facilities Informed: USPASS keeps its member facilities informed about market trends, payer requirements, and potential contracting opportunities.
- Facilitating Contract Review and Understanding: While not providing legal advice, USPASS can help facilities understand the key terms and conditions of proposed contracts.
- Building Strong Payer Relationships: USPASS's commitment to fostering positive relationships with MCOs benefits its network members by creating a more collaborative environment for contracting.
Credentialing: A Smooth and Efficient Process
The credentialing process, required by payors to ensure quality and compliance, can be cumbersome and time-sensitive for healthcare providers. USPASS streamlines this process for its member facilities by:
- Managing the Paperwork: USPASS often handles the initial collection and submission of credentialing documents, reducing the administrative burden on facility staff.
- Ensuring Completeness and Accuracy: USPASS helps facilities ensure that their credentialing applications are complete and accurate, minimizing delays and potential rejections.
- Maintaining Up-to-Date Information: USPASS may assist in keeping credentialing information current with the relevant payors, reducing the risk of disruptions in payment or network participation.
- Facilitating Communication with Payors: USPASS can act as a point of contact between the facility and the MCO's credentialing department, resolving any questions or issues that may arise.
- Promoting Timely Credentialing: USPASS understands the importance of timely credentialing for network participation and strives to expedite the process whenever possible.
Claims Assistance: Navigating Payment Challenges
Dealing with claim denials, payment delays, and other reimbursement issues can be a significant source of frustration and financial strain for skilled nursing facilities. USPASS offers valuable assistance in this area by:
- Troubleshooting Claim Issues: When facilities encounter payment problems, USPASS can help investigate the reasons for denial or delay.
- Pinpointing the Root Cause: Leveraging its understanding of payer policies and procedures, USPASS can help identify the specific issue preventing payment.
- Facilitating Communication with Payors: USPASS acts as a liaison, communicating with the appropriate individuals at the MCO to understand the issue and advocate for resolution.
- Leveraging Payer Relationships: USPASS's established relationships with payors can often facilitate a faster and more positive outcome in resolving claim disputes.
- Providing Guidance on Billing Practices: While not a billing service, USPASS's experience can offer insights into best practices for claim submission to minimize errors and delays.
Case Management: Connecting with the Right Resources
Skilled nursing facilities often encounter challenges related to case management decisions made by MCOs, such as level of care authorizations, discharge planning, and disenrollments. USPASS can provide support by:
- Facilitating Communication with MCO Staff: USPASS can help facilities connect with the appropriate case managers and other relevant personnel at the MCO to discuss specific patient cases.
- Providing a Point of Contact: USPASS can act as an intermediary, streamlining communication and ensuring that the facility's concerns are heard by the right individuals.
- Assisting with Understanding MCO Processes: USPASS's familiarity with MCO procedures can help facilities navigate complex case management requirements.
- Advocating for Appropriate Care Levels: While clinical decisions remain with the MCO, USPASS can help ensure that the facility's perspective on the appropriate level of care is considered.
- Supporting Continuity of Care: By facilitating communication and understanding, USPASS contributes to a smoother transition of care for patients.
In essence, USPASS aims to be more than just a network administrator; it strives to be a proactive partner that understands the operational and financial realities of skilled nursing facilities and provides tangible support to help them succeed within the managed care environment.
To discuss how USPASS can support your facility, please contact us today.
Phone:
973-686-3233 877-465-7277
Fax: 973-686-3668
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