Add a New Managed Care Provider
- Meagan Prost
Cloud Knowledge Base Home / Provider Relations / Network Expansion / Add a New Managed Care Provider
Streamline your managed care referral process, provide clients easy access to vital services, and strengthen your network for comprehensive, cost-effective support.
In this guide, we’ll cover:
Important: If you're utilizing Providerfiles, be aware that there are a couple additional steps required to register the provider on the portal and initiate authorization transmissions.
Set up a new managed care provider file
Effortlessly incorporate a new managed care provider into your clinical network by following these simple steps:
Click the downward arrow next to the green New button in the top menu bar
Select Clinical/Community Resource > Managed Care Provider
Complete the File
Given the uniqueness of each EAP and the specific information collected, required fields and workflows may vary. Consider these instructions as a baseline, and adapt them as needed to align with your team's specific requirements and processes.
Important: Use the 'Save' button periodically while working on a file to save your progress. When finished, click the 'Save and Close' button to save your work and exit the file.
Details Tab
Consider this tab the provider’s profile, where you can input essential information and record any dates of unavailability.
Enter information into the provided fields
Tip: If your group manages appointments for this managed care provider, remember to mark 'Show in Scheduler' to display the provider on the calendar in the Scheduler Module.
Click the Save button to save and continue working on the file
Contacts/Activities
This tab is purposefully designed to track time dedicated to interactions and account management, covering provider outreach, follow-up, and more.
Initiate a new time or activity entry by clicking the green New button
Record your time, add any necessary notes, and click Save and Close
Clinical Office Location
Specify the office location(s) where the provider is available for appointments. This ensures optimal matching when your team searches for a provider within a designated geographic area for the client.
Click the green Add button to add an office
Search for an existing location or click the green Add button to input details for a new office
Remember to tick the' Show in Scheduler' box if your team schedules appointments at the provider's office location(s) using the Scheduler Module.
Click Save and Close to save the new location
If necessary, include another location by following the same steps
Click the Save button to save your changes and continue working on the provider file
Note: Referrals whose profiles lack an office location won't show up in the Clinical Resources search when a radius is specified. Your system administrator(s) can locate such providers using the 'Clinical Based Search' tool.
Physicians
Click the' Add' button to link one or more physicians to this managed care provider profile.
Rates
Incorporate hourly or flat rates based on the provider's contract.
Once added to their profile, the system will seamlessly apply them to authorizations for the selected service in the future, streamlining your workflow.
Click the green Add button to create a rate
Note: You can include different rates, such as paying one rate for in-person sessions and another rate for virtual sessions.
Click the Save button to save your additions
License/Liability
Input the provider details in this tab to ensure accurate client matching with a provider with an active license and liability insurance.
Important: EAP Expert Cloud will generate a pop-up alert if it attempts to match a client with a provider with an inactive license or insufficient liability coverage based on the details entered in this tab.
This alert will not prevent you from assigning the provider and sending the authorization.
Enter details efficiently using the green New buttons in the designated areas
Remember to click the Save button to save the updates
Feedback
If client feedback about this provider is documented and managed, it is listed as a historical log in this tab. Additionally, you can create new feedback directly within this provider tab.
To add feedback, click the green New button
Link the feedback to a case or organization to document commendations or concerns related to a service in which this provider was involved
Click the Save and Close button to return to the provider’s profile
Authorizations
This tab is a comprehensive log of authorized services for a managed care provider.
Additional Info
This tab is utilized to input a series of established questions and enter corresponding answers to capture any additional information that may be required.
Click the green New button
Select one or multiple ‘Question Set’ from the list to add to this tab and click Save and Close
Click on the line item of the linked Question Set to open the set of questions and complete
Click OK to save and exit the list of questions
Note: Your system administrator(s) has created the list of available questions.
If you need to make any necessary modifications, including adding new questions or a new question set to choose from, please contact them directly.
Attributes
For optimal client matching based on preferences, utilize this tab to input the provider's service specialties, spoken languages, and searchable credentials.
Use the green Add buttons to add one or multiple entries per attribute
Click the Save button to save the updates and continue working on the file
Working Hours
If your team is managing client appointments for this managed care provider through the Scheduler Module, it's essential to input the provider's availability in this tab.
Click the green New button to begin adding the provider’s availability
You might need multiple entries if the provider's schedule varies by day and/or office location.
Enter details of the provider’s availability
Utilize the clinical search field to find the provider.
Select the office location corresponding to this new schedule.
Specify the start date and set the available start and end time
Note: If you know of upcoming dates when this managed care provider will be out of the office (within this availability), kindly input them into the Unavailabilities sub-tab.
Utilize the recurrence feature for establishing an ongoing schedule
This feature offers a variety of options similar to those found in other scheduling tools.
Select the Save and Close button, and observe the newly added entry in the Working Hours tab
Click Save to save the changes and continue working in the provider file
Note: If this managed care provider exclusively serves specific organizations or groups, they should be added to the 'Preferred Providers' tab within the Organization/Group module for streamlined assignment.
Integrated provider management
Navigate through these relevant sections for efficient management of provider relations tasks.
Assigning a Managed Care Provider to a Case
Discover the process of assigning a provider and generating/sending a service authorization.
Overseeing Provider Quality Assurance
Gain proficiency in handling a provider's schedule, monitoring credentials that have expiration dates, and documenting client feedback.
Communication Channels with Providers
Efficiently engage with providers through prompt email communication.
Effectively convey information using file alerts while maintaining organization and task management.
Approving or Denying Provider Invoices
Enter provider claims, manage payment statuses, and look up payment status inquiries.
Troubleshooting Information
Here are a few tips when adding a new managed care provider to your Clinical Resources network:
Double-Check Provider Information: Before adding the new provider, ensure you have accurate and complete information about them, including their credentials, contact details, and service offerings.
Check for Data Entry Errors: When entering the provider's details, carefully review the information for typos or errors. Accurate data entry prevents issues in matching clients and generating authorizations.
Test the Matching Functionality: After adding the new provider, perform a test match to ensure that clients can be successfully paired with them. Verify that the system generates authorizations accurately and reflects the correct service details.
If you encounter persistent issues, don't hesitate to contact your system administrator(s).
