WE PROVIDE YEARS OF MANAGED CARE EXPERIENCE

Our Managed Care Administration (MCA) group offers a business line designed to support the administration of capitated services including enrollment/eligibility, capitation reconciliations and payments, claims and encounters, referrals and authorizations, utilization and quality management, and customer service. We support all types of capitation arrangements including PCP, specialty, facility, global, risk pools, performance incentives and all hybrid combinations. Our expertise in managed care administrative services is driven by our organizational experience, skilled staff, advanced technology, transactional efficiency, complete operational and data integration, sophisticated management reporting and analysis, and commitment to providing the best quality service to our clients.

Service Lines

Sutter Physician Services can support the range of payer service lines including:

• Commercial
• Medicare
• Medi-Cal
• Other Public Programs
• Self-Insured
• Workers Compensation

Service Functions

Some of the specific managed care administration service functions that Sutter Physician Services performs include:

• Claims Adjudication and Payment
• Cost and Performance Analysis
• Credentialing
• Customer Service/Call Center
• Enrollment/Eligibility
• Encounter Processing
• Finance and Financial Statements
• Incoming/Outgoing Capitation Management
• Information Technology
• Medical and Utilization Analysis
• Provider Relations
• Quality Management
• Recovery Services
• Referral and Authorization Processing
• Staffing
• Utilization Management

Managed Care Administration Focus

High volume, high quality processing of health care transactions and performance monitoring and analysis are a primary focus of the Managed Care Administration group. Staff teams are organized by client to establish expertise with each specific client's operating requirements within each of the major operational areas - claims, eligibility, recovery and medical management - while at the same time operating under standard process protocols. This approach ensures consistency and efficiency, allowing high volume processing within an infrastructure designed for operational efficiency, quality performance and client responsiveness.

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More information:
Managed Care Administration
Billing and Accounts Receivable Management
Technology
Reporting and Analysis
Service and Performance
Independent Practice Services

Check out Doing Business with Sutter Physician Services for more information about our services and how Sutter Physician Services can help your organization.