Provider Support Services provided by Customer Service Representatives
Our Provider Support representatives engage in detailed telephonic conversations with providers, following-up on critical clinical information and coverage details related to our client’s beneficiaries. This support service is mediated exclusively by our experienced team of Pharmacists and Physicians, creating an environment where providers can speak directly with other healthcare professionals for improved professionalism and clinical efficiency.
Coverage related Information:
Benefit Determination
Coverage Details
Eligibility Status
Provider related Information, including PCP assigned to the Insured
Queries related to Authorization
Follow-Up on Documentation sent by the Provider to the Insurance Company
Information related to Exceptional Circumstances
Contracted Rates for Providers for Various Service Codes
Credentialing Status of the Provider
Demographic Details of a Provider
Requesting Changes in Demographic Details for a Provider
Claims related Information:
Allowable Amount, Paid Amount and Check Details
Denials of Service Lines
Service Line Billing
Mailing Address and Electronic Payer Id Confirmation for Submission of Claims
Provider Group and Individual Claim Details
Follow-Up on Resubmitted or Corrected Claims
Status and Follow-Up on Appeals
Duplicate Claim Enquiries
Back Office Duties related to Provider Support Services
Our Provider Support teams work closely with other functional areas to improve the efficiency and accuracy of our client’s operations. They are the front line and by utilizing their analytical reports, Sun Knowledge’s seasoned professionals create blue prints identifying gaps and their corresponding corrective action plans.
