Capabilities

Collaboration with National and State Regulatory Agencies

MHU consults with national investigative agencies, state departments of insurance, state departments of health plan regulation and other agencies to provide a broad range of services, including:

 

Routine Surveys of Health Plan Compliance

In concert with regulatory agencies, MHU conducts routine surveys and reporting to ensure health plan compliance in the areas of quality management, member grievances and appeals, access and availability of services, utilization management and overall plan performance in meeting members’ health care needs. Upon completion of the survey, we issue a comprehensive report outlining deficiencies. We will also conduct survey follow-ups to ensure deficiencies have been corrected within the required time period.

  

Non Routine Surveys and Investigations

MHU works with state and federal agencies to initiate timely investigations into issues raised by consumers, providers, the Legislature, watchdog agencies and other stakeholders. Areas of expertise include:

 

Claims Investigations

MHU is an expert in claims evaluation.  We prepare and conduct comprehensive claims surveys to evaluate claims payment procedures of large managed care and insurance companies. Our comprehensive claims investigation process includes our “360 degree view” approach. This means we take the broadest possible view during investigations, examining inter-related operations, such as medical management, contract management and grievance and appeals, to help us gain the most complete picture of the health plan’s claims operations. This allows us to understand where deficiencies may occur throughout the chain of operational procedures. 

We have an intimate understanding of the complexities of health plan provider payment contracts, from capitation to fee for service, partial risk payments, shared risk payments and full risk payments.  We also have a deep understanding of the various network arrangements between and among networks and providers. The complexities of these many arrangements often result in confusion and unintended consequences for physicians and consumers who get caught in the middle of inefficient payment processes and end up with claim denials and unexpected bills. We assist regulators in understanding the complexities and root causes of claims-related grievances and provider disputes and assist health plans in developing effective claims practices that will result in fewer procedural deficiencies down the road.

 

Contact Us Today

Managed Healthcare Unlimited, Inc
133 The Promenade North Unit #323
Long Beach, CA, 90802

Phone: (562) 436-3451
Fax: (562)437-8334

Email Contacts
General Questions: This email address is being protected from spambots. You need JavaScript enabled to view it.
Rose Leidl: This email address is being protected from spambots. You need JavaScript enabled to view it.
Pat Schano: This email address is being protected from spambots. You need JavaScript enabled to view it.

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