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Hometown Health Departments ___________________________________________________
Compliance
The Compliance Department oversees the health plan to detect , correct , and prevent non-compliance .
Credentialing
Credentialing is a division of Network Services department . Credentialing is responsible for compliance of primary and secondary verification of credentialing applications from providers who are participating as a preferred provider .
Customer Service
The Customer Service Department provides information on benefits , authorizations , claims , eligibility and other questions from members , providers , and employers via telephone , e-mail , personal contact and correspondence .
Finance
The Finance Department services include asset protection , regulatory reporting , underwriting and financial statement reporting . It also houses member eligibility , accounts receivable , accounts payable , and assists in the development of financial information systems to meet business needs and regulatory requirements .
Healthcare Utilization Management
The Healthcare Utilization Management Department coordinates requests for referral authorization and clinical utilization management of members to promote medically necessary high-quality care in an optimal setting . National guidelines provided by MCG ( formerly Milliman Care Guidelines ), Hayes Technology Assessments are used to determine medical necessity for services . CMS policies are used to review requests for Senior Care Plus products . URAC , formerly the Utilization Review Accreditation Commission who accredits Hometown Health ,