Account Management
- Account Executive
- Key contact for implementations and ongoing strategies
A Delta Rural Healthcare Services Account Executive is assigned to each client to act as the Point of Contact to facilitate all aspects of your health benefit program. Regularly scheduled meetings will provide an opportunity to discuss issues, additional development, review reports, and provide documentation of quality assurance. This individual is the key contact for scheduled implementations and ongoing strategies.
Member Services
- Eligibility Management
- Member ID Cards and Plan Information
One key to success for any Managed Care organization is to have accurate eligibility. A company’s eligibility reputation can have a major impression on their members and their provider network. It is critical to guarantee that you are receiving premium payments for members that are eligible and not continuing to pay claims for members that are no longer eligible.
Delta Rural Healthcare Services has extensive experience developing interfaces with CMS and other national payers, ensuring the eligibility information updates timely and accurately.
Another crucial element of a successful Health Plan organization is a timely relaying of plan information to covered members, explaining their benefits, in an easily understandable format. We have established goals that member ID cards and benefit information are sent out within the timeframes each of our clients select, typically between
Claims Management
- Electronic claim submission or scanning of paper claims
- Adjudication of all claim types based on plan parameters and provider reimbursement
- Fraud and Abuse Edits
- Printing of Checks and Explanation of Benefits
- Subrogation and Coordination of Benefits
- Hospital Bill Audits
Through our proprietary Information System software, Delta Rural Healthcare Services is able to integrate all of its management functions and automate the communication of claims information to the payers and providers.
Our approach to claims processing is to maintain and continually improve our existing system that affords providers an efficient, user-friendly method for submitting claims while providing accurate and timely reports to our clients.
The Delta Rural Healthcare Services Information System has the ability to pay claims under a number of reimbursement mechanisms. We have experience in capitation, fee-for-service, per diems, discounts, and DRGs. Additionally, we have implemented the use of case rates on several contracts. Claims can be submitted electronically or via paper.
The Delta Rural Healthcare Services Claims Team is comprised of experienced claim professionals. Staffing levels are reviewed regularly and adjusted accordingly, ensuring the expeditious processing of claims.
Medical Affairs
- Pre-Certifications
- Referral Authorizations
- Continuation of Care
- Transition of Care
- Disease Management
- Case Management
- Quality Assurance
- Physician Utilization
Delta Rural Healthcare Services has put together a Medical Affairs Team of highly skilled professionals that ensure high quality and cost-effective healthcare is received in the most appropriate setting. The Team focuses on the overall clinical management of each member along the entire continuum of care.
The Medical Affairs Team performs reviews for determining medical necessity for designated outpatient procedures, inpatient admissions, and continued stays. Milliman & Robertson (M&R) Healthcare Management Guidelines
Provider Relations & Contracting
- Network Analysis and Recruitment
- Provider Contracting
- Provider Credentialing
- Provider Database Maintenance
- Provider Education
Delta Rural Healthcare Services has over 10 years of experience in Provider Contracting and Network Development. We have formed and managed Independent Physician Associations (IPAs) for some of the largest payers in the country, many of them at financial risk for their services. We have also developed provider networks for Medicare, PPO, and Managed Care programs. Delta Rural Healthcare Services also has the ability to credential providers utilizing all NCQA guidelines.
Maintaining an accurate provider database is crucial for correct claim payments, updated provider directories, and satisfied providers. We have created and have the ability to maintain multiple networks within our system utilizing various reimbursement methodologies. We pride ourselves on the flexibility and features our network database can provide.
Regulatory & Statutory Consulting
- Compliance
- Audit Preparation and Consulting
- Regulatory Filings
- Statutory Filings
- Federal Filings
Delta Rural Healthcare Services has a team of professionals that can continualy monitor compliance issues and assure that all necessary fillings are handled in a timely manner. We have worked with various states and the federal government applying for numerous licenses. We understand how tedious this process can be and how important it is to an organization. We can provide this service for your organization or we can offer consulting services based on your needs.