HP Collaborating Dept
Primarily responsible for provider education, issue resolution, provider satisfaction, and regional network awareness.
Account Management
Responsible for pended inventory, adjustment requests, correspondence, appeals, and projects.
Claims Shop
Responsible for Trial Check Runs and perform post-production CR Audits.
COA
Ensures provider and ancillary contracts are completed and executed for network participation.
Contract Management
Responsible for processing Macro/BOT requests that are submitted and are processed according to instructions provided.
Automation Team
Creates and submits Change Requests (CRs) for Amisys configuration.
CIA
Manages all facility, physician, and group data for all SHP lines of business.
Provider Data Management
Responsible for generating and sending recovery notification letters to providers when a claim recovery is needed.
Recovery Team
Responsible for reviewing inquiries and creating projects for the reprocessing of claims.
CL
Manages the process of reviewing, verifying, and validating health care provider's information with state licensing agencies and the National Provider Data Bank.
Credentialing
Responsible for building and implementing the behavioral health business rules so that BH claims auto-adjudicate correctly.
Configuration
Responsible for tracking interest for the Medicaid line of business, and for reviewing and responding to internal audits.
Review Division
They are responsible for creating authorizations for STAR Plus, MMP, STAR Kids, and STAR Health members who are eligible for Long Term Services and Support (LTSS).
CAT
Maintains pre-adjudication scrubs
Encounters