Zotec Partners, a leader in revenue cycle management, delivers a comprehensive offering to assist medical groups nationwide with both in and out of network (OON) claims processing strategies. This initiative leverages the No Surprises Act (NSA) and managed care contracting. The aim is to provide fair and efficient reimbursement solutions regardless of a group’s network status.
Zotec views the ultimate goal of disputing reimbursements of OON claims in the NSA independent dispute resolution (IDR) process as a means to leverage contract negotiations. For in-network claims, Zotec Partners offers advanced capabilities in analyzing, monitoring, and facilitating contracting, renewal, and renegotiation discussions. The Zotec team of highly skilled contract negotiators brings a deep understanding of market dynamics. This ensures that medical groups can achieve favorable terms. Zotec has implemented substantial documentation processes, crucial for supporting the NSA’s IDR process and through State-based claims dispute resolution, solidifying their position in negotiations.
When it comes to OON claims, Zotec provides end-to-end facilitation, navigating the complexities of State and Federal balance billing restrictions. Zotec’s team includes subject matter experts and functional automation, allowing for efficient handling of high-volume claims. This comprehensive approach not only supports in-network contracting but also builds a robust case for out-of-network positioning through the IDR process.
Zotec emphasizes the importance of meticulous documentation and strategic planning in claims processing. Key practices include:
The primary goal of Zotec’s approach is to achieve fair and mutually beneficial reimbursement, regardless of network status. Utilizing outcomes from State and Federal processes, Zotec gains leverage in negotiations for in-network status, supports key factors used in IDR reviews, and enhances the ability to project and trend by payer, state, and specialty. This unified strategy also streamlines communication with health plans and simplifies the resolution of claims projects through single case agreements and TPA claims processing.
Zotec’s team of accounts receivable (AR) professionals brings extensive knowledge and experience to managed care negotiations and the IDR process. Could your medical group benefit from support in managed care contracting or navigating the No Surprises Act? Contact a Zotec team member today to begin optimizing your claims processing strategies.
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