Claims DepartmentThe claims department manages all aspects of provider payment, including the processing and tracking of claims. Routine provider notifications include evidence of payments (EOPs) and 836 reports.
Medical Management The management of chronic conditions and disease states is a critical component to providing comprehensive, preventative care. With the support of the medical management department, network providers are able to deliver customized case management and consultation to our Members.
PharmacyAffinity’s pharmacy services routinely provides up-to-date information to network providers about formularies, prior authorization criteria, and step therapy programs. Our pharmacists will assist you in providing cost-effective pharmaceuticals to improve care.
Quality Management Affinity’s quality management department supports providers in delivering timely preventive and primary care services to our Members, as guided by local, State and federal health care standards, including the New York State Quality Assurance Reporting Requirements. Through educational and incentive initiatives, Affinity’s quality management department continually works with network providers to improve clinical performance.
Vendor and Institutional RelationsVendor & Institutional Relations performs two distinct functions. We develop and nurture relationships with our institutional providers, including our contracted hospitals and federally qualified health centers. Representatives are available by phone and in person to assist these providers with issues resolution, as well as to partner on key initiatives.
Additionally, we provide oversight and contract management for all of Affinity’s medical vendors, including Superior Vision, DentaQuest, Express Scripts, Landmark, and Beacon, which offer vision, dental, prescription, chiropractic and mental health/substance abuse services, respectively, to our Members. In 2009, we expect to implement additional vendors to enhance our services, including radiology and transportation. Affinity values our health care partners, as they enable us to offer the comprehensive range of services our Members need and expect.