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Network Management

The primary goal of CAIPA Network Management is to improve quality and clinical excellence for our providers and patients, and to allow providers to practice medicine with little or no administrative burden.

This is done through a number of functions performed daily by CAIPA staff, such as liaison between health plans and doctors to resolve claims issues, overpayments and recovery, audits, vouchers and demographic updates. CAIPA is also actively negotiating with the VBP’s health plans. CAIPA will simplify the resolution of these issues and eliminate barriers to providers through designated health plan representatives.

CAIPA employees provide resources for practice when our providers and their employees encounter difficulties accessing program resources. While most cases are handled by health plan representatives, it is sometimes appropriate to upgrade to CAIPA to attract health plan managers to focus on key issues that will affect IPA practices.

Our knowledgeable, professional and friendly staff is committed to supporting and educating our doctors about managed care policies. They are strategically assigned to physicians in our IPA network to ensure maximum communication and to assist physicians and office workers in the following areas of operation.

New provider orientation and office staff training

  • Risk adjustment plan
  • Portal and web-based meetings
  • Regular on-site visits with doctors and office staff
  • Use management, claims, head fees, qualifications, quality improvement, reimbursement, and other network operations solutions
  • Quality / HEDIS / STAR measurement resources
  • State, Medicare and/or Health Plan Policy Updates
  • Documents and re-vouchers
  • Demographic update
  • Nursing training mode