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3rd Party Payer Case Study

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2. Negotiate and administer 3rd party payer contracts
I. Contracts should be renegotiated every year in order to save money for the county. There are several contracts that have not been renegotiated by the Contracts department.
Example #1- Missed deadline on Anthem contract-04/27/2016
• Terry missed the deadline to renegotiate the Anthem contract for higher rates.
• Even though an email was sent as a reminder to renegotiate the rates by the Anthem.
Example #2- Dental 3rd party payer contracts-9/20/2016
• Terry was asked to acquire and review the dental contract on 09/20/2016.
• Eric asked for an update on 10/24/2016 and Terry stated that they are still gathering the information from the 3rd party payers.
• She will provide an update later that week. No updates were given.
…show more content…
Example #4- Lithotripsy patient-03/02/2017
• Terry is trying to have Chuck or Ursula sign the LOA even though Catherine has not approved. Terry does not have the authority to make such decisions.

5. Equipment, Services, Supplies contracts
I. Contracts reviewed and redlined by Kim and Terry have errors in them.
II. There have been some complaints about Kim Welbourn lacking the knowledge to do her job efficiently. Example #1- Contract with Philip-08/03/2016
• Terry did not fully read the contract because her emails indicate that she is misinformed.
• Terry in the email is stating that Amerinet’s terms and conditions are applied. However, there is a stipulation in the contract which states that Philip’s terms and conditions will supersede any other terms and conditions. Example #2- MOU with Oxnard College-08/31/2016
• Terry was asked to establish an MOU with Oxnard College and contact Armine and work with him.
• Terry was assigned this task on 8/31/2016.
• Armine provided Terry with a template for the MOU.
• Terry let the ball drop and did not do

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