Service for Providers

Services for GWHP Participating Providers through Cedar Gate Technologies  

Network Management

CONTRACTING

  • Dedicated managed care personnel focused on contracting new providers and growing the GHWP network. 

  • Includes negotiation of Payer and/or Employer agreements and management of network relationships on behalf of GWHP.

  • The GWHP Contracting & Network Development team continuously reviews and pursues bundle growth opportunities with Payers and Employers that allows GWHP Providers to participate in value-based contracts while maintaining existing employment structure.

CLIENT PERFORMANCE  

  • In-Person, white glove approach to Provider and Practice support through the Cedar Gate Client Performance team who serves as the go-to resource and primary point of contact.

  • Approach includes recurring performance review with practices, including claims-based revenue cycle performance as well as individualized provider metrics based on bundle financial performance levers and targets.

Revenue Cycle & Bundles Administration 

BILLING

  • Management of all inbound and outbound claims for GWHP-related services including charge capture, package, and bundles review.

  • Provider offices are asked to submit appropriate claims to a dedicated GWHP electronic payer ID. Upon receipt of the claim, GWHP processes your claims and reprices them into the appropriate bundled package price. 

CLAIMS PROCESSING

  • Claims that are rejected by the payer for lapses in coverage will be validated and appropriate denials will be issued with the appropriate denial and remark codes.

  • Claims submitted to the payer that are denied may result in a GWHP Denial of Service that is transmitted in the standard ERAs with the appropriate denial and remark codes.

PAYMENT OPERATIONS

  • The GWHP team controls the unbundling of bulk payments received from the Payer or Employer and downstream distribution of payment to applicable participating GWHP providers.

  • Once payer payments are received, the GWHP team will post these payments and any adjustments to the appropriate patient accounts. Provider payments are issued weekly through the Finance Department. 

  • Cedar Gate’s payment technology separates out each provider’s portion of the bundle and distributes a standard EOB/ERA for seamless payment posting back into the provider’s billing system.

  • A dedicated provider portal is available when you have status questions regarding your provider’s charges. However, each provider’s Client Performance representative can assist with urgent inquiries through our dedicated model. 

CREDENTIALING & QUALITY

  • GWHP has dedicated Credentialing and Quality Management committees to help evaluate the efficiency and quality of both prospective and active GWHP physicians. Both committees play a critical role in ensuring that GWHP maintains a narrow network of high-performing physicians who are able to operate and succeed in a fully at-risk bundled episode of care.

  • The GWHP Credentialing Committee and Quality Management Committee are each physician-led by GWHP physicians and provide a unique opportunity for physicians who are looking to participate in a leadership position within a value-based care organization.

COLLECTIONS

  • Appropriate payer inquiry and follow up on your GWHP-related bundle claims.

  • Dedicated personnel will follow up with the payer on outstanding claims and payments on behalf of GWHP providers, including appropriate payer inquiry and follow up on your GWHP-related bundle claims.