Utilization Management
MedPOINT’s Utilization Management Department encompasses three main areas: outpatient review, inpatient review and case management. Overall, the utilization management program is designed to ensure consistent care delivery by encouraging high quality of care in the most appropriate setting from our highly qualified provider network.
Quality Management
MedPOINT has a comprehensive and integrated Quality Management Program. It is setup to objectively and systematically monitor and evaluate quality, appropriateness and outcome of care and services along with the processes by which they are delivered to IPA members.
Claims Operations
MedPOINT’s Claims Operations Department is responsible for timely routing and proper adjudication of all claims to meet regulatory timeliness and payment guidelines established for each line of business.
Credentialing
MedPOINT facilitates credentialing verification for all IPA contracted practitioners. This includes initial credentialing and recredentialing which aligns with the NCQA 3-year cycle.
Provider Network Operations
MedPOINT’s Provider Network Operations department serves as a liaison between contracted HMOs and providers; advising the providers of new policies and procedures as they become available through continuous interaction.
Case Management
MedPOINT’s Case Management department consists of RNs, LVNs, social workers and other allied health workers. The dedicated case management staff are assigned to members with chronic conditions or other needs that require one or more of the following services.
Eligibility and Benefits
MedPOINT Management’s eligibility department tracks and maintains current and historical eligibility information for all contracted health plans.
Call Center
MedPOINT supports three separate call centers for members and providers for by UM and claims issues. Each center is staffed with knowledgeable staff available to quickly assist callers.
Financial Management
MedPOINT’s financial management team and processes are focused on one thing – the long term success of our clients. Timely and accurate accounting and reporting enable MedPOINT and our clients to accurately control resources and know exactly where they are now and how they are doing.
Hospital Operations
MedPOINT’s Hospital Operations Department helps to manage risk pools and ensure continuity and quality of care for capitated members during hospitalization.