Network Management Support

We are your network management resource. We deliver superior utilization management support services.

With Data Marshall, you gain our team of qualified medical practitioners to manage PCP to specialist referrals, auto authorizations, inpatient admission notification plus the ability to forward documentation for medical director review. We add code review service and DX descriptions to CPT and ICD-9 to create comprehensive solutions. Every member of Data Marshall's utilization management team puts their in-depth provider and payer knowledge to work for their clients.

Fee Negotiation Support Services

Claim re-pricing and out-of-network fee negotiation proposal processing is conducted by the experienced team that Data Marshall delivers to their payer partners. Our staff qualify physicians for network expansion to minimize efforts required by client provider network management teams.

  • Administrative support activity for provider fee negotiation process.
  • Facilitate further efforts through the appropriate interpretation of the provider response.
  • Stringent turnaround times.
  • Highest accuracy requirement exceeding 99.5%, as it involves the financial negotiations directly with providers.
  • Receive the returned proposals from providers throughout the day, from Monday through Friday
  • Employ 3 shift operations, covering the inflow from all time zones to stay within the 24Hrs of TAT
  • Watch for the slightest possibility of savings through the tone of response given by provider & steer efforts for maximum realization.
  • Set aside the proposals being rejected due to provider policies to restrict further proposal reaching providers, resulting in both reduction of administrative costs and TAT.

Provider Contracting Services

Data Marshall assists the Provider networks in expanding their network, by reaching out to the out-of-network providers and encouraging them to join the Provider networks. With our experience supporting Payers & Provider network organizations and expertise in understanding the nuances of claim reimbursements, Data Marshall executives are able to communicate the benefits of assured and expedited reimbursements of joining the network to the providers.

  • Support the network in collecting & analyzing the out-of-network claims history & identify the list of top out-of-network providers based on volume of claims & dollar amount.
  • Obtain the contact information & attempt to call the physician office to explain the benefits of participating with the network.
  • Explain the terms & conditions at a high level & negotiate further on the rates.
  • Persistent follow up with the providers, inclined to sign up with the network.
  • Get the contract proposal signed, send for execution/loading to have future claims paid out as in-network with agreed upon discounts.
  • Highlight the benefits that network offers, while emphasizing the down side of having claims processed as out-of-network.
  • Strategize the provider contracting approach according to the location, specialty and the specific provider’s previous billing pattern.
  • Initial & lead/follow up calls handled by separate teams, considering that lead calls could become definitive.
  • Plan the shifts & call types according to the time zones to derive greater success rate.
  • Create positive atmosphere by being responsive to provider’s questions & apprehensions.
  • Make use of the statastic tools that help the user a base rate to the approach each speciality & location.

Presented below are a few instances where Data Marshall has been able to enhance the process deliverables for the ‘Provider Contracting’ function

Value Propositions

  • 15% increase in the overall discounts generated, through the help of exposure gained in ‘out-of-network fee negotiation’ process.
  • 8% increase in number of contracts signed through the effective negotiation attempts, across physicians & hospitals.
  • 30% reduction in overall operational expenditure.
  • Significant rise in success rate, through the insights collected from provider domain on the key components that they look for while signing a contract.

Provider Database Management

Data Marshall will streamline your provider database management.

For provider matching, provider updates or facility update maintenance, Data Marshall has a well established and proven process in place for every client. Your provider database is accurately updated every time a change, deletion or addition notification is received.

Data Marshall provides ‘Provider Enrollment’ services for Primary & Supplementary PPOs.

  • Work through an email channel to receive updates from existing providers & hospitals and update them into the system.
  • Familiarise the new providers with Network by sending them the copy of actual contracts & welcome kits.
  • Load the new contracts into the database with appropriate contractual terms.
  • Respond to the providers queries with regards to the eligibility & applicable rates
  • Redirect the queries outside the scope of Enrollments function to respective departments
  • Requirement for higher accuracy levels & the need for responsiveness.
  • Receive the provider updates through provider contractors, dedicated email & Fax channels and work through them on FIFO basis.
  • Once the new contract is loaded into the system, initiate the communication with providers by sending them contract copies & user manuals.
  • Maintain the TAT of 24 Hrs.
  • Schedule the provider updates & E-mail communication based on the time zones to ensure seamless communication with providers.

case studies

Enrolment Maintenance for a growing TPA located in Wisconsin.

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Claims Adjudication for a growing TPA located in Wisconsin.

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Claims Reconsideration for an Established IPA in East coast.

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