A few Words —ProviderLink
In order to create the opportunity to streamline a variety of processes, we have created a provider-facing portal, called ProviderLink. If selected as your vendor, we would launch ProviderLink on behalf of our payers, allowing providers (nominated by our payers) to have access.
The ProviderLink allowes access to the following
On-Line Treatment Authorization Requests
Providers are able to make on-line treatment authorization requests that feed directly into the CareWare system, allowing those requests to be triaged and managed by the payer's staff in CareWare.
Bill/Payment Status Inquiries
Payment status inquiry calls typically represent the largest number of provider calls a claim operation handles. Assuming we can capture the information outlined below, we can post the status of the bill or payment directly to ProviderLink, eliminating those provider calls.
The type of information posted could include:
- • Client Received Date
- • BR Received Date
- • EDI date into the Claim System
- • Paid Date (Available because of state reporting requirements)
Electronic EOR / EOB View & Delivery
The ProviderLink Portal provides payees with the ability to access and view their specific medical bill payment data and download the Explanations of Review (EOR) or Explanations of Benefits (EOB) in PDF formats. This will cut down or eliminate these types of inquiries by the provider. This capability could also enable EFT processing.
Dispute Resolution/Reconsideration Processing
It is our intention to build a process in the ProviderLink to allow providers to manage their reconsideration/2nd Bill review process online.
Online Provider Registration
ProviderLink is available for online provider registration allowing payees to register to take advantage of all of the resources available through the portal. Clients have the ability to configure access to the portal based on their requirements. This "single registration" process identifies the payee, links the payee to all payers in the system, and generates a user ID and password for the payee.
Prospective Agreement of Reimbursement
Certain requests that come through ProviderLink or CareWare (our UR module) can be configured to be pre-approved according to parameters set by our Payors. These approvals could potentially include the application of the OMFS to the request, eliminating bill review on those procedures.
Document Management Systems Compatibility
Output from the system (consisting of Check, EOR and payment data) can be provided in image formats for import directly into that payers existing or future document management systems. This feature supports paperless claim file management and document storage.