Consulting Services

Our core consulting services focus on government and commercial health programs from both sides: our provider-physicians and health carriers (MCO, HMO, MSO, TPA). We concentrate on their perspectives and assist with relationship building by identifying their common goals.

Insuring Sources’ team has over 100 years of combined experience in operational and clinical services, risk management, contracting, marketing and sales expertise. We assist our clients to develop unique member acquisition strategies, obtain provider contracts, analyze prevailing Federal and State policies to make recommendations while increasing value, effectiveness and results.

Our team’s expertise as health care industry leaders is a product of past experience coupled with continuous policy analysis and proactive actions in each of our consultant’s area of expertise.

Connecting Health Plans, Specialty Networks, School Based Health Clinics and Provider Organizations.

Senior Management Team

Mary Saiz:

Summary of QualificationsTwenty five years of senior management experience with local and national health insurance and managed care organizations. Experience in operations, claims, product development, compliance, sales and marketing. Senior Management team lead for NCQA and AAHC accreditation committees, product development, involved with provider network integrations and product migrations for multiple mergers and acquisitions.

Pat Ritcher:

Summary QualificationsOver 26 years of experience in managed health care, with a focus on quality and process improvement. Clinical Director of the accreditation team at United Healthcare and Medica Health Plans which exceeded accreditation standards (for NCQA and AAAHC) by upholding three consecutive years of ratings through rigorous and continuous evaluation and application of compliance regulations and guidelines. Integrated quality improvement measures and medical management strategies into the provider credentialing, utilization management, provider relations, marketing, member services, claims, and risk management.

Senior Management Team

Nancy B. Mongiovanni:

Summary QualificationsOver 25 years of contracted work with Managed Care Organizations and start up healthcare companies’ operational and infrastructure development, physician practice management, licensure, regulations and compliance. Details include systems development, risk evaluation, billing/collections, policy, and implementation strategies.

In today's SBHC environment, the work being done at each clinic regarding student’s health outcomes are in line with the health outcome goals and mandates established by each States' Medicaid programs.

The documentation of the student’s health assessments and outcomes is the main attraction of the MCO's to an SBHC setting. This data should open the SBHC’s door to the prospect of contracting with every MCO in their specific County and State.

In particular are those States in which Medicaid has transitioned to mandated Managed Care Organizations.

Medicaid Managed Care Organizations (MCOs)and SBHCs

Review the SBHC’s credentialing, billing capabilities and data collection.

Provide recommendations before contracting efforts begin if needed.

Review SBHC’s clinical reports and data collection (HEDIS, health assessments, patient encounter data as required by the State’s Medicaid and the Managed Care Providers).

Prepare a presentation highlighting the SBHC’s operations and reflect the relevant data that the MCO’s are interested in (use SBHC’s White Paper and any other available data).◦ The presentation should demonstrate that by partnering with the SBHC the MCO’s will clearly see

that the SBHC’s program has and will continue to lower costs through prevention, more appropriate care and increased access to care, services, and benefits.

Engage with the Managed Care Organizations ◦ Provide guidance, support and recommendations. ◦ Initiate contracting efforts

Scope of Work

Follow up with the MCOs until they extend a contract.◦ Provide guidance, support and recommendations.

SBHC is to complete the contract and make sure all physicians, ARNP and PA (if applicable) are included in the credentialing process.

SBHC is to engage with MCO during the contracting phase and begin to work with them on a marketing and outreach campaign.

Scope of Work