Our Services

Managed Care Contract Offers - The CHCS managed care portfolio includes approximately 30 contracts. Additional contract discussions are ongoing. CHCS and its staff work with payers to develop favorable contract offers that facilitate access to its network members at fair rates of reimbursement.

Contract Administration and Management - CHCS handles the contract administration and management on behalf of its members. Staff is knowledgeable of contractor policies and procedures, payment methodologies and practices and other requirements. CHCS members are provided timely information about the agreements in which they participate as well as any policy/procedural changes that may impact them.

Contract Performance Monitoring - CHCS agreements are monitored on an ongoing basis with a comprehensive review completed each year. These reviews are based on data and information solicited from all CHCS members as well as findings from CHCS staff monitoring of contractor compliance with terms.

Assistance with Contract Negotiations - A full assessment of current and potential contracts are examined and approved by using the CHCS Board standards and guidelines. CHCS works to capture new contractual opportunities to improve the cost and quality of healthcare for the members and patients we serve and achieve optimal reimbursement. These contracts are reviewed by CHCS legal counsel to ensure the language is fair and reasonable.

Troubleshooting for Providers and Their Staffs - CHCS' Provider Relations staff work directly with members on managed care issues and the application of related policies and procedures. This "troubleshooting" service is a valuable time saver for members and their staff. Our Provider Relations staff hosts and coordinates the activities of the Managers' Forum that is offered to Administration and staff from all member practice groups. The Managers' Forum meets annually. Its participants are able to surface issues of interest or concern, network with peers and obtain useful educational offerings in a group setting. In addition, the Managers' Forum enables CHCS to obtain valuable input and advice from its members.

Research on claim/payor Issues - CHCS serves as an advocate to assist our members with claim issues that cannot be resolved using the normal avenues and result in the delay of reimbursement. the PHO also captures market trends or changes to reimbursement policies to ensure the offices have the most up-to-date payment policies and guidelines.

Physician Liaison Sponsorship - The CHCS PHO has a team of dedicated physician liaisons who provide the tools and information the members needed for assistance with:

• Physician referrals
• Appointment rescheduling
• Remote access to patient care information
• Communication regarding a patient
• Physician-to-physician consults; and
• General questions or concerns

Call our Physician Services team toll-free at 1-800-777-7700 or locally at 501-364-5901.

Quarterly Meetings with Provider Relations Director - The CHCS Provider Relations Director holds a quarterly meeting with the member representatives to continue to maintain a trusting relationship with our members and referring physicians throughout our network.

Children's Healthcare System, Inc. (CHCS) has been approved as a delegate for credentialing by most of its managed care contractors. Credentialing is performed in accordance with current managed care standards promulgated by the National Committee for Quality Assurance (NCQA) and other such organizations.

CHCS Providers complete a single credentialing application at the time they join the corporation and are re-credentialed every two years thereafter. CHCS staff respond to all inquiries and requests of its managed care contractors after the Provider completes his or her initial credentialing. This service eliminates most of the paperwork and time Providers traditionally invest in managed care credentialing activities.

Ongoing Education Regarding Managed Care - CHCS members and their employees may draw on CHCS staff's managed care expertise through in-office in-services and monthly newsletters. Specific educational offerings are available on request.

Health Insurance Market knowledge/relationships - CHCS provides its members with up-to-date market-related information on a variety of payer related and legal issues. CHCS often meets with local representatives and valuable contacts throughout the state to keep abreast of current healthcare changes or issues. CHCS distributes valuable tools and resources on a regular basis to our PHO members to eliminate the time expended on staff research and development.

CHCS is a standing member of the Child Health Advantage physician purchase program by way of ACH's membership with the Children's Hospital Association. CHCS members have access to a wide variety of discount products and services such as vaccines, medical/surgical supplies, pharmaceuticals, and other business services.