Managed Care Contracting-The Good, The Bad, The Ugly

[3746] Managed Care Contracting-The Good, The Bad, The Ugly
Learn important steps for successful insurance contracting and much more!

Presentation Info:

• TAHC&H Event | Winter Conference | Recorded for On-Demand Access
• Presentation Date | February 9, 2023

Education-Training Credits:

• TX HCSSA Administrator/Alternate Continuing Education
• 1.0 Clock Hr(s)

HCSSA Topic(s) Addressed:

• §558.259[d][4]agency responsibilities
• §558.260[a][7]financial management
• §558.260[a][9]community resources

Program Description: In this presentation you will learn important steps for successful insurance contracting, how to access your payor market for open or closed networks, how to request patient authorization while still in credentialing, request rate increases and much more vital information.

TAHC&H Faculty/Presenter(s): Beverly Sepulveda, MBA, BSN, RN, CEO, Founder, Principle Consultant, SynerImages Healthcare Consulting

About the Presenter(s): Beverly Sepulveda is the founder, CEO, and Principle consultant for SynerImages Healthcare Consulting, a national healthcare and regulatory consulting firm in operation for over 23 years. She holds a Master's in Business Administration and a Bachelor of Science in Nursing. Her nursing specialization is in quality assurance and accreditation compliance. Ms. Sepulveda's consulting expertise covers a broad array of areas including Home Health Agencies, Therapy clinics, ORFs, CORFs, Hospitals and the MCO industry. Ms. Sepulveda's company specializes in start-up healthcare business seeking state and federal licensure, cloud-based policies and procedures, on-going regulatory compliance services and insurance contracting assistance.

Prior to her working for SynerImages, Ms. Sepulveda was the Executive Director for PCA Health plans of Texas [later purchased by Humana] and held senior management positions with Aetna, CIGNA, and MetLife insurance companies. Her medical experience was at St. David's Hospital, Bellaire Hospital, Critical Care of America Home Health, North American Medical Management and Princeton Medical Management services.

SynerImages is a Texas-based healthcare consulting firm with offices in Houston and South Texas. In addition to offering home health startup and compliance services, her firm also facilitates other business needs such coordinating medical equipment inspections, application management services, educational conferences/webinars and other business operations assistance.

[3746] Managed Care Contracting-The Good, The Bad, The Ugly