| PRODUCTS |  | | | Medicare Advantage
Health Plans Private Fee For Service Plans | | |
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| | PROVIDER SERVICES | | | | Provider Relations
Heritage ensures that the recruitment, contracting, orientation and maintenance of a provider network for the delivery of quality health care and payer contracts are consistent with the parameters of state and federal regulatory guidelines. Heritage assists in resolving provider questions and issues in a timely manner and develops and implements action plans to educate and train on current guidelines and changes in the industry.
Provider Contracting
Heritage negotiates contract terms, conditions and rates with qualified providers and health care agencies according to company standards and applicable laws and regulations. We ensure the successful implementation and management of executed contracts, as well as resolve provider related contractual issues. Heritage periodically monitors provider groups to ensure they meet all required company, NCQA, HCFA and TDI contract, accessibility, availability, and quality standards, as well as applicable laws and regulations.
Electronic Provider Services
Heritage has several electronic services available for exchanging information between physicians, health plans, independent physician associations (IPAs), managed care organizations (MCOs), and management service organizations (MSOs). Two of these services are MC-NET and EDI claims submission. Both services deliver a fast, accurate, and controlled method that enable business partners to view health care information including claims, eligibility, and authorizations, as well as submit claims and authorizations. These and other electronic services that Heritage offer help to reduce the cost of sharing information by reducing telephone calls, faxes, and paper submission while improving the accuracy of information and claims turnaround time. For more information regarding electronic services, please contact EDI services (713) 843-6780 or by e-mail edi@hhsi.com.
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