Prospect Medical Systems and are our management services organizations. They provide knowledgeable support to our physicians and members through case management, authorization reviews, referrals, claims processing, member services, on-line tools, provider relations, health education resources and the latest in technological advances allowing our doctors to do what they do best—care for our members.
Smaller groups often do not have the resources, staff, and infrastructure to cover the additional overhead involved in daily operations. We assist with claims processing, referral processing, contracting, auditing, payment disputes, financial services and reporting, network management, member services, information systems and tech support, case management, utilization review, credentialing, Hierarchical Condition Coding (HCC) and Pay for Performance (P4P) training, strategic planning and other necessary functions. We also understand the ever-changing marketplace.
We help our IPA clients grow their business, not just manage their existing lives. We can create marketing collateral aimed at increasing the visibility and awareness of the managed group. And we have business development strategies to create opportunities for dual eligible conversions, primary care physician recruitment, and ethnic market development. By providing “turn-key” operations with integrated management services, both quality health care and cost savings are realized by the providers, patients, and payers.