Please enable JavaScript.
Coggle requires JavaScript to display documents.
On Boarding, Audit Request, Provider Services, Provider Portals, Clover…
On Boarding
Credentialing
Internal Cred
Delegated
Annual Audit
Potentila CAP (only happened once)
Request for updated roster
initial Cred
out reach for info missing from network team submission (practitioner or ancillary)
decision letter
Recred (3 years)
Vendor :Andros get from Elizabeth)
decision letter
CAQH outreach for to get # attestation
Network Contracting
roster
W-9
contract
delegation agreement
CA agreement
Provider Data Management
In Network
Newly Contracted
Adhoc Outreach of Clarification (rare)
Contracted Providers
Add/Change/Terms (Provider initiated)
via network contact/provider solutrion
email
"providers@cloverhealth.com
- SF ticket)
response emails
Request ofr updated roster
OON
Intake Claim
w-9 if needed (rare)
Configuration
Audit Request
PAyment Integrity
Prepay Audit
Programs
DRG Review
REadmissions
High Dollar
MRR
MRR Review Response
Notification of Adjustment (EOP)
Claim Stays as billed
Observation
ED Analyzer (Optum)
InPatient Psych
Itemized Bill review (Optum)
Audit Announcement
Provider Portal
Provider Navnet
Letter
Post Audit
Risk Adjustment
Special Investigation Unti
Provider Services
Appeals
Disputes
Provider Portals
Clover Provider Website
NaviNet
Clover Assistant
Activiation
Payments