CRS claims adjudication teams work closely with contracted
providers to make sure claims submitted are processed and paid in a
timely and accurately. CRS supports providers billing staff with a
host of services designed to make sure that claims are being
submitted cleanly and on time.
Claims Processing
CRS claims adjudication teams work closely with contracted
providers to make sure claims submitted are processed and paid in
timely and accurate manner. CRS supports providers billing staff
with a host of services designed to make sure that claims are being
submitted cleanly and on time.
Authorized services performed by contracted CRS providers on
enrolled patients, eligible for services are paid according to the
terms of the contract in place at the date of service. The CRS
claims adjudication system provides edits that support the accurate
processing of claims. Claims falling short of fulfilling all
the clean claim criteria are returned with a request for additional
information.
Support Services
The CRS program provides a wide variety of claim process support
services including Provider Relations, Claims Inquiry, Managed Care
and Claims dispute services.
Provider Relations staff work closely with providers and group
practices. Their focus is contracting, staff education and acting
as a liaison between the provider and the CRS program. You may
reach our Provider Relations representative by sending a message
through contact us.
A Claims Inquiry representative is available to support billing
staff with questions about the claims status and clarification
about unpaid claims. You may reach our claims inquiry
representative through contract us.
The Managed Care staff provides membership eligibility,
authorization and Inpatient utilization review support. Inquirers
regarding Managed Care questions may be directed to members of that
team through contacting us.
Claims dispute services are available to provider staff
believing a claim has not been paid correctly. You may find the
claims dispute form under the forms section of this site or contact
a CRS representative through contact us.
Last Updated July 1, 2007