Services

Professional Services
- Utilization Management
  
  MedPOINT’s Utilization Management Department encompasses three main areas: outpatient review, inpatient review, and case management (described in more detail; see below). Essentially, the utilization management umbrella is designed to ensure consistent care delivery by encouraging high quality of care in the most appropriate setting from our highly qualified provider network. The patient’s clinical information is collected to determine the level of care needed and that the proposed treatment is medically necessary. Members of the health care team follow the patient throughout the healthcare delivery system and ensure that appropriate facilities and resources are utilized.
  
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- Quality Management
  
  MedPOINT supports a comprehensive and integrated Quality Management Program. Its overarching goal is to objectively and systematically monitor and evaluate the quality, appropriateness, and outcome of care and services delivered to IPA members.
  
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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.

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Credentialing

MedPOINT facilitates credentialing verification for all IPA contracted practitioners. This includes initial credentialing and recredentialing which aligns with the NCQA 3-year cycle.

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Provider Network Operations

MedPOINT’s Provider Network Operations (PNO) department serves as a liaison between contracted providers and HMOs. Services include advising providers of new policies and procedures, recommending best practices, answering questions, and assisting with issue resolution. Another key function revolves around provider activation and directory reconciliation which includes facilitating new provider training. PNO also supports provider contracting to ensure network specialty access is maintained.

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Case Management/Transition of Care

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.

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Eligibility and Benefits

MedPOINT Management’s eligibility department tracks and maintains current and historical eligibility information for all contracted health plans.

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Call Centers

MedPOINT supports three separate call centers for members and providers to assist with UM and claims questions. Each center is staffed with knowledgeable teammates who are available to quickly assist callers. A dedicated Spanish call center is also supported and other language interpretation is available as needed.

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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.

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Hospital Operations

MedPOINT’s Hospital Operations Department helps to manage risk pools and ensure continuity and quality of care for capitated members during hospitalization.

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