Payor Access to CSI Network Services
Value of CSI Network
Elimination of network management administration costs:
- Delegated credentialing and ongoing data maintenance consistent with NCQA standardsContract management for all service types (IV, SN, OT, PT, ST, PDN, Hospice) regardless of organization size or type
- Network quality monitoring and reporting, resulting in provider panel exclusion when appropriate
- Adverse event reporting and investigation by in-house certified nurses ensuring quality throughout the network
- Provider training and education regarding payor programs and policies
Reduction in Referral and Utilization Management costs:
- CSI reduces out of network costs through referral management, statewide coverage, and absorption of out of network provider charges
- CSI markets its care coordination services to hospital systems and physician providers resulting in higher referral rates to CSI which allows us to manage provider and service utilization
- CSI knows its business and payor policies and practices, providing a single point of authorization requests to payor, reducing the overall number and length of costly authorization and eligibility calls
- CSI manages agency requests for initial and additional services providing the payor with the necessary data to make appropriate care decisions for its members and ensuring efficient utilization of payor's costly case management resources
- CSI provides payor with one resource to resolve difficult multi-disciplinary cases
- CSI provides care coordination across all service needs delivering efficient, patient friendly post acute transitions
Reduction in the overall cost of claim adjudication:
- CSI provides accurate and timely claims adjudication of provider claims
- CSI handles all aspects of provider customer service including billing, claims status and payment questions
- CSI aggregates all provider claim submissions reducing payor claim issues and ensuring clean claims
Reduction in overall cost of care:
- Reduction of both in and out of network costs by providing multi-service care coordination
- One-stop care coordination for discharged patients improves patient and hospital system satisfaction
- Development and implementation of successful therapy and care management programs resulting in, sharp reductions of therapy days and corresponding costs while improving outcomes. This has come at the expense of CSI as a reduction in TPN revenue
- CSI's comprehensive approach to care management recognizes the global cost of care contribution associated with inpatient re-admission, patient non-compliance and other adverse patient outcomes
|
