提供者手册

网络管理功能

Carelon recognizes and acknowledges that our provider network is not only crucial to the success of our program, but also serves as one of our major “clients.” Because of this philosophy, network management functions have been carefully designed to provide a full range of services to our participating providers. These services are described below.

会员和提供商服务人员的工作时间为东部标准时间上午 8:00 至下午 5:00，周一至周五，可拨打免费提供商热线 877-615-8503。

会员和提供者服务代表负责直接处理问题或将提供者转介给负责特定领域的其他工作人员。他们与提供者服务相关的部门职能包括：

• 一般供应商信息；
• 理赔计费说明；
• 理赔调整研究；和
• 提供者教育和问题解决。

分配到特定县或项目的提供者现场协调员提供以下职能：

• Provider-facing and in the field
• Recruitment
• Focus on all providers achieving success and improving provider experience by implementing a high-touch relationship-driven service model
• Signatories for PROMISe enrollment attestation
• Assess network adequacy & availability
• We consider our providers partners!
  • Through partnership, we are looking to create a lasting impact and creating administrative simplicity so providers can continue being the experts in caring for their patients – our members.