Noridian Healthcare Solutions
Member Level: VendorVendor Overview
Description of Services: For nearly 60 years, Noridian Healthcare Solutions has provided transformational back-office services for health plans and government payers across the nation. Noridian closely collaborates with partners to administer services affecting nearly 400,000 providers and 24 million health care recipients in all 50 states and several U.S. Territories. By outsourcing administrative services to Noridian, health programs can focus on other top priorities – like ensuring their members have access to quality health care.
So, what can we do for your health plan? We help solve your operational challenges including some of these key areas:
CMS Compliance
As the Supplemental Medical Review Contractor (SMRC) for Centers for Medicare & Medicaid Services (CMS), we conduct nationwide medical reviews of Medicaid, Medicare Part A/B, and to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claims to determine whether claims follow coverage, coding, payment, and billing requirements to lower improper payments and noncompliance. For your health plan, we can provide the following services:
• Expertise in applying clinical and coding guidelines that meet the highest standards
• Ongoing research to ensure compliance with state and federal laws and regulations
• Guidance on medical policy creation and modifications to stay ahead of compliance
• Identify your vulnerabilities and develop targeted initiatives to support fraud, waste & abuse identification
• RNs who are Certified Fraud Examiners (CFE) and Clinical Coders with certifications across multiple categories
Business Process Outsourcing
Working with Noridian means access to our more than 2,000 employees across a variety of sectors, including more than 350 physicians, nurses and other health care clinicians. In addition, our shared resources model supports your health plan’s need to be agile in seizing new opportunities and mitigating risks. For your health plan we can provide the following resources:
• Technology: Shared technology lowers your capital costs by improving efficiencies, enhancing data security and compliance, efficiently implementing operational upgrades and automations, and minimizing the need for physical space
• Human Capital: Shared human capital to lower your operational costs by enabling organizations to quickly scale up or down, with staff who are experienced with multiple systems and processes
• Expertise: Shared expertise to maximize effectiveness by giving you access to clinical and compliance experts, which reduces risks, and lessens the impact of turnover and lowers indirect costs
Provider Credentialing
For both Medicare and Medicaid programs, we provide outsourced credentialing services for providers across the nation, processing nearly 230,000 provider enrollment applications yearly. Our experienced staff can be quickly deployed for efficient, high-quality credentialing operations. We implement best practices to meet industry standard metrics, and support provider network teams with customized, educational materials. For your health plan, we can provide the following services:
• Optimize provider credentialing processes to increase efficiency and decrease overhead
• Collaborate to develop a shared strategy and key performance indicators
• Mitigate impact of workforce shortages and staff turnover that creates disruption
• Improve efficiencies and quickly scale up or scale down based on your needs
• Give your in-house provider teams more time to focus on provider network management and value-driven provider relations
These areas and others, including payment integrity and utilization management, is how Noridian can help elevate your health plan operations. Contact us to learn more.
Jennie ML Ossentjuk, Market Lead, Commercial Health Plans
Phone: 845-636-0539
Email: jennie.ossentjuk@noridian.com
Primary Service: Administrative Systems
Secondary Service: Core System
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4510 13th Ave S
Fargo, ND 58103
701-715-9067
https://www.noridiansolutions.com/