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.