S&S Management, Inc

OUR SERVICES

CAPITATION

S&S Management, Inc. offers various options for processes monthly capitation payments for primary care and specialty providers. Capitation detail reports to support calculations accompany each payment. Membership and capitation payment information is also available on-demand for providers to access through our Provider Portal.

CASE MANAGEMENT

The S&S Management, Inc. Case Management team is comprised of RNs, LVNs and other support staff. We work closely with members, caregivers, physicians and health plans to create and manage treatment plans, coordinate healthcare services and connect members to resources available to keep them healthy and in the community.

CLAIMS OPERATIONS

The Claims Department ensures all claims are received are processed and paid correctly according to regulatory requirements. S&S Managment, Inc. encourages electronic claims submission from providers directly through the Provider Portal and Office Ally.

CONTRACTING/PROVIDER RELATIONS

S&S Management, Inc. has a team of professionals who are knowledgeable in various reimbursement methodologies and experience negotiating managed care contracts with payors and providers. They are able to resolve escalated issues, build networks as well as support physicians through education and training.

CREDENTIALING

S&S Management, Inc. handles all credentialing and recredentialing of providers for its clients according to NCQA requirements. Upon verification of all credentialing information, providers are presented to the Credentialing Committee on a monthly basis, and as needed, to review and approve files. S&S Management, Inc. provides ongoing monitoring of practitioner sanctions, complaints and quality issues.

ELIGIBLITY AND BENEFITS

Participating providers are able to access member eligibility information through the Provider Portal. Eligibility is updated on a daily, weekly or monthly based on the time/frequency the information is received from health plans. Prior to posting eligibility data into the Provider Portal, S&S Management, Inc. reconciles the information to ensures its accuracy.

FINANCIAL ANALYSIS & REPORTING

In addition to preparing and submitting financial reports to meet regulatory and health plan requirements, S&S Management, Inc. provides its clients with various reports which include key metrics to monitor and track performance, identify opportunities for revenue, improve quality of care, lower costs and to help drive strategic decisions.
Robust audit processes are in place to ensure data integrity. Reconciliations are regularly performed on all incoming revenue and outgoing payments.

HEDIS/RISK ADJUSTMENT

S&S Management, Inc. has a team of HEDIS and Risk Adjustment Specialists who work closely with providers year-round on risk adjustment coding and HEDIS initiatives. The team facilitates completion of annual well visits, leads interventions, conducts chart reviews and administers provider incentives to promote quality health care services.

QUALITY MANAGEMENT

S&S Management, Inc. has a Quality Management Program to evaluate, monitor and ensure that all members are able to access quality health care services and receive stellar customer service. S&S Management continuously reviews and monitors data such as, but not limited to, complaints, grievances, sentinel events, claims, authorizations to identify opportunities for improvement.

UTILIZATION MANAGEMENT

The Utilization Management team is comprised of clinical staff, including Medical Directors and physician reviewers. As service requests are received, the team applies clinical guidelines to ensure the delivery of quality health care services to members in the most appropriate setting.
The Provider Portal is available for participating providers to submit service requests. The system allows providers to submit supporting medical notes and other information needed for clinical review.

TECHNOLOGY

Technology is critical to effective and efficient healthcare management services. S&S Management, Inc. uses MSO Exec, a web-based proprietary system, for core functions such as claims, eligibility, authorizations, etc. A Provider Portal is available for participating providers. Portal access and training is available for new providers and as requested.

CUSTOMER SERVICE

There are knowledgeable customer service representatives available to assist members, providers and other callers during business hours. Callers may be routed to different departments for further assistance, if needed. Messages received are responded to within 24-28 hours of receipt.

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