Quality and comprehensive healthcare services
Independent Physician Association (IPAs) are dedicated to providing quality and value in health care. IPAs also serve as an extension of each individual member’s office. RAPHA IPA manages the full spectrum of IPA services. These include managed care contracting, practice enhancements, and education for our members. We provide clients with an opportunity to maintain their independence . Therefore, this secures their current and future patients through an organization that is solely governed by physicians.
Managed Care Contracting
In addition, our IPA management services RAPHA IPA is able to leverage our managed care contracting expertise to negotiate contracts on behalf of the association. For instance, this includes:
- Fee-for-service and incentive-based contracting
- Managed Care Market Analysis for service areas
- Contract Language Review
- Delegated Credentialing
Practice Enhancements
In addition, RAPHA IPA can help grow the network of benefits offered to IPA members with the development and management of purchasing programs. Through our vast network of relationships, we are able to form programs which offer savings for members. Including but not limited to malpractice insurance and clinical supplies. Also included are office supplies and reference laboratory services.
Education
RAPHA IPA believes that in today’s rapidly evolving healthcare market. Our provision of accurate and unbiased updates about healthcare legislation and market trends to our clients. Consequently, this is an invaluable service in maintaining viable healthcare practices.
In support of these services, RAPHA IPA also provides critical support to each IPA members practice. This includes individual practice fee analysis, claims research and resolution, network meetings and education.
Mandatory Clinical Criteria Information for Medicare Contracts
Members can access the criteria used in the decision-making process by clicking on the following links:
- CMS Medicare Coverage Database- https://www.cms.gov/medicare-
coverage-database/search.aspx
Clients with Brand New Day contracts need to have the following:
- Brand New Day Clinical Criteria- https://www.bndhmo.com/
clinical-criteria
Clients with Central Health Plan contracts need to have the following:
- Central Health Plan Clinical Criteria- https://www.centralhealthplan.
com/Member/ClinicalCriteria
Clients that have Bright Health Care, aka Brand New Day or Central Health Plan, also need to have this link posted:
- Bright Health Plan Clinical Guidelines- https://brighthealth.access.
mcg.com/index
If you have any questions, please feel free to contact us through phone, email, or form submissions!