staff is focused on the details necessary to accurately process claims at an average of 15 days or less. Our adjudicators are proven analytical problem solvers trained in the healthcare industry standards, claims adjudication, and system functionality.
Claims administration highlights include:
- EDI and custom file submission capabilities
- Average clean claims turnaround time is 90% processed in 15 days or less
- Implementation of proprietary CCI and custom audit procedures ensuring adjudication accuracy
- Full compliance with regulatory and HMO processing requirements
- Weekly check runs including electronic EOB capabilities
- Aggressive refund recovery process
- Consistently achieved top ranking in health plan audits
Eligibility services runs our member eligibility electronically from the associated health plans. This information is immediately loaded into our database, which meets our goal to ensure accuracy, timeliness and integrity of the information that is provided to our clients.
Member Eligibility Options:
- Web-based accessibility
- eMail accessibility for eligibility inquiries
- Phone inquiries – dedicated client line
- Fax inquiries
- Monthly electronic eligibility reports for current and retroactive membership
Additionally, NAMM takes a proactive member education approach by sending
new payer members a customized client Welcome Letter. NAMM also provides notification
to members if their Primary Care Physician (PCP) will be leaving the IPA/PHO and
will assist members in choosing and transferring to another PCP. Eligibility reconciliation
is a vital part of the membership tracking process, helping to ensure that each
IPA and PHO is receiving appropriate HMO reimbursement.