Department in an insurance company that helps providers solve claims problems and offers educational workshops about policies and procedures. Also called provider services or relationship management .

Procedure that gives providers a chance to communicate any misconduct related to federal health care agencies whereby the provider may have lesser restitution than had the information not been revealed. Also called voluntary disclosure protocol.

Document created by the facility that shows annual costs and expenses incurred in treating Medicare patients. Medicare gathers the reimbursement information from this report for Medicare services (e.g., ambulatory surgery, end-stage renal disease, laboratory, orthotics, outpatient diagnostic services, prosthetics, radiology). The Uniform Bill (UB-04) billing data must be accurate because it affects the facility’s reimbursement received through the PS & R reporting system and cost-report settlement process.

Information collected through a survey or focus group of providers who participate in the Medicaid program and have provided services to enrolled Medicaid beneficiaries. The state or a contractor of the state may conduct the survey.

Automated voice-response system that allows the provider to use the telephone to obtain checkwrite, claim, and prior authorization information for services rendered through the Medi-Cal program and several other state programs.

Method that identifies providers and follows all contacts made to correct problems (e.g., provider’s eligibility, medical necessity issue, repeat billing abusers).