Wiki Function of Provider Relations Support

[ollielooya]

Can someone who works from a payer side offer a general list of just what it is that Provider Relation Officer's are supposed to do? Is there a general rule when their services should be utilized? Additionally, what should be the next step when such people are non-responsive to emails and phone calls, when the carrier suggested in the first place that their services might be appropriate?

---Suzanne E. Byrum CPC

 

[ajs]

Can someone who works from a payer side offer a general list of just what it is that Provider Relation Officer's are supposed to do? Is there a general rule when their services should be utilized? Additionally, what should be the next step when such people are non-responsive to emails and phone calls, when the carrier suggested in the first place that their services might be appropriate?

---Suzanne E. Byrum CPC

I am not sure of what the actual duties are, but in general I believe the Provider Relations person is suppose to assist the providers with any problems relating to contracts, credentialing, and most any problem that is not resolved with other departments within the insurance carrier's offices.

If a provider relations person is not responsive, I would go to the medical director for the carrier. Your other option here in Washington state is to contact the Washington State Medical Association in Seattle. They will go to bat for providers in this state that are having issues with an insurance carrier.

Let me know if you need any help in this area.