Network Claims Administration

• Currently enter 70% of all claims electronically
• Average monthly volume of 240,000 claims
• Average turnaround time of 20 days for all claims
• Department is fully compliant with all CMS and HMO requirements and consistently top-ranked in health plan audits

NAMM California proudly pays claims promptly and accurately. On average, the department handles over 240,000 claims per month providing an average turnaround time for capitated and fee-for-service encounters of just 20 days. Our strong audit procedures and pre-check run reviews ensure the accuracy of payments before any checks are mailed out. NAMM California is fully compliant with CMS, DMHC, and HMO claims payment requirements and has consistently scored in the top percentile on claims audits.

Contracting

• Considerable size provides greater leverage during negotiations
• Limited Knox-Keene License provides access to full risk contracts

NAMM California's size allows for greater leverage during contract negotiations. Physicians improve their bottom line results through our effective and efficient management of both capitated and fee-for-service contracts. Our services include coordination of health plan meetings, termination processes, and resolution of both member and operational issues. NAMM California holds a limited Knox-Keene license which enables physician partners to access full risk capabilities and to address recent legislative solvency requirements in a cost-effective manner.

Credentialing

• Consistent high scores on all HMO audits
• Expedited process enables affiliated groups to add providers quickly and efficiently

Our experienced staff consistently receives high scores on all HMO audits. NAMM California has developed an expedited credentialing process enabling affiliated groups to add providers quickly and efficiently.

Eligibility

We currently receive 100% of our HMO eligibility information electronically from our contracted health plans. Loading it directly into our system ensures the accuracy, timeliness and integrity of the information the physician receives. We continuously update the eligibility information available online to physician offices and also provide monthly reports to our MD offices.