ACO REACH Services
Claims Processing
- Claims Reduction File Intake
- Process Claims
- Capitation, Refunds, Adjustments
- Claims Repricing
Data Management
- Beneficiary and Provider Data
- Claims, Credentialing, Eligibility
- HIPAA Compliant In-House Servers
- Incoming/Outgoing File Loading
Provider Payments
- Weekly Claims Payments
- Capitation and Care Management
- Shared Savings
- 835, EOP, ACH, Paper
Mailings
- Less Than 1% Returned Mail
- Beneficiary Mailings
- HIPAA Compliant Printing Services
- HEDR Mailings
Customer Service
- 9.4 Avg Speed of Answer
- In-House Customer Service Team
- Beneficiary and Provider
- Fluent in English and Spanish
- Call Recording
Reporting
- Call Tracking Reports
- Aligned, Newly Aligned, VA Reports
- Confirmation Reports on All Mailings
- Audit and Compliance Assistance
Voluntary Aligament
- Over 70% Acceptance Rate
- VA Intake by Fax, Mail, Electronic
- HIPAA Compliant Digital and Original Storage
- SVA Reporting and Response File Intake
In early 2022 the Centers for Medicare and Medicaid (CMS) announced they were developing a new model of care for Medicare fee-for-service patients to help improve patient outcomes and address underserved communities. The ACO Realizing Equity, Access, and Community Health (REACH) model would build upon the previous successes of the Global and Professional Direct Contracting (GPDC) model and the Medicare Shared Savings Program (MSSP). This new ACO REACH structure would offer more efficient care coordination for beneficiaries and high risks and rewards for participating providers. The goal is to lower the cost of care by improving patient’s healthy equity and provide a higher quality of services to underrepresented populations.
SMG has worked closely with our ACO REACH partners at Medical Home Network (MHN) to successfully develop and implement extensive claims processing workflows, customer service platforms, care coordination payments, voluntary alignment procedures, provider correspondence, CMS reporting requirements, and beneficiary outreach across multiple regions and communities. We are proud to offer our services to ACOs participating in this new Medicare ACO REACH model and committed to achieving the highest standards in health care administration.
SCAS Management Group (SMG) provides services to a 25,000+ beneficiary REACH ACO that operates FQHCs in multiple states. In addition to the services listed above, we also offer REACH ACOs consulting, analytics and care management platforms, customized reporting, weekly collaborative meetings, and policy and procedure development.
For more information on our REACH ACO administration services, please contact Jonathan Felix at 414-755-3610 or at Jonathan.Felix@Scasmg.com