OPERATIONS 

FEATURES

Operational Management: regulatory compliance, enrollment verification, physician and patient enrollment, credentialing, HMO coordination, medical records maintenance, fee schedule review, reimbursement analysis, claims adjudication, physician and patient grievance & appeals system, liability insurance and reinsurance review, claims recovery / subrogation

Our team of professional experts understand the complex requirements of the healthcare industry and has a reputation for forward-looking, creative problem-solving on behalf of clients.

• Over the past few years, despite stricter rules and regulations and increased audits and scrutiny the health plans and regulatory agencies, MSO, Inc. has been able to maintain compliance for all of its managed IPAs.  Most of the audit scores received by MSO, Inc. on behalf of the IPAs are 100% for credentialing, claims, network operations, compliance and information systems.

• Utilization Management and Quality Management are held to a much stricter standard but MSO, Inc. has always received above 85% and most of the time over 95%.  MSO utilization management staff continuously monitor authorization turn-around time and contact the IPA Medical Directors via phone, text and e-mails to try to achieve the highest audit scores.