Our services are meaningful to large and small provider networks as well as to the individual care provider. Our comprehensive services support and enhance our healthcare providers' ability to deliver quality patient care, increase productivity and reduce administrative overhead. Our goal is to help providers meet the needs and demands of their patients, providing the tools, processes and support that allow them to exceed their patient's expectations, improve their care and maintain their competitive advantage.

CMO currently supports four independent provider associations (IPAs) with over 2400 credentialed professionals in the Montefiore Medical Center delivery system.

If you are interested in more information or joining one of our provider networks, contact us at cmoproviderrelations@montefiore.org or call us at (914) 377.4477

Our Provider Services include:

Care Management
Disease Management
Practice Guildelines and Protocols
Eligibility
Claims Processing & Billing
Electronic Claims Submission
Contract Administration
Credentialing
Communications
Patient Education
Network Development & Marketing

Care Management
CMO provides a new paradigm for care management that goes beyond the silos of case management, disease management, behavioral health and health promotion although we possesses a rich expertise in each of these areas. The company's CMO Care Continuity model focuses on serving the individual, not managing a medical episode or treating a chronic condition. Our collaborative "care team" strategy emphasizes the interaction and communication between patients and their healthcare providers with emphasis on placing the primary care physician at the center of team.
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Disease Management
Our Disease Management Services extend from population profiling, patient identification, assessment and program enrollment to working hand-in-hand with primary care providers, specialists, pharmacists and our members to create and manage treatment plans. We provide attentive management, best practices treatment protocols and self-management skills training to empower members to be educated consumers of healthcare and to actively participate in improving the quality of their lives.
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Practice Guildelines and Protocols
CMO regularly convenes multidisciplinary design and improvement teams of physicians, nurses, pharmacists, researchers and specialists to review, discuss and modify nationally recognized, disease-specific guidelines. With this guidance, CMO develops evidence-based, best practice treatment protocols. Once established, CMO supplies the infrastructure for disseminating this best practice information to participating physicians, conducts education seminars for clinicians and develops patient education materials.
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Eligibility
Using Care Link, an integrated web application, participating providers can verify member eligibility, determine primary care capitation, submit referrals for consultations and office visits to participating providers, obtain authorizations for elective hospital admissions, and view the status of referral and authorization requests previously made. Membership information is continually updated for new and terminated members to ensure accurate eligibility and that claims will be processed properly.
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Claims Processing & Billing
CMO delivers a full complement of lifecycle claims management services. Through end-to-end best-practice business processes, our experienced staff and state-of-the-art technology, CMO provides accurate and timely processing of claims. Our years of experience have resulted in excellent first pass rates and timely adjudication for our clients. Our familiarity with many different benefit plans and payers gives us the flexibility to customize how we receive and adjudicate claims based on the specific requirements of a plan. CMO's claims processing system uses proven technology to ensure accuracy, maximize efficiency and shorten the bill-to-pay cycle. Bill review services are also available to provide an additional level of security.
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Electronic Claims Submission
CMO has initiated an Electronic Claims Submission Program (ECSP) that allows providers to electronically submit claims to the CMO. Our electronic claims submission offers the following benefits:

More timely and efficient claims payment

Automated responses to providers

Greater reliability than paper submissions

Reduced paperwork for office staff

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Contract Administration
CMO negotiates, implements and monitors managed care contracts for provider networks and negotiates with providers and vendors for services outside of the network. We provide services to help translate managed care contractlanguage into actionable policies and procedures to maintain contract compliance. Our skills include contract language interpretation, expert negotiation and financial analysis.
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Credentialing
CMO's Credentialing Department simplifies the credentialing process for providers to ensure that physicians are properly appointed and reappointed to their network or hospital according to the specific need of the organization and meet the standards for professional qualifications in accordance with organization Bylaws,the National Committee for Quality Assurance (NCQA) and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). Provider Directory Information Management CMO manages all aspects of a provider database including processing and forwarding profiles to health plans, health plan reconciliation, network reports and provider directories
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Communications
CMO can serve as a communication link between hospitals, provider networks, and health plans. Provider Relations Liaisons offer a variety of services such as orientation and educational sessions for office staff on policies and procedures of the health care delivery system.
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Patient Education
CMO can provide a medical practice with a host of patient education materials and disease management worksheets.
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Network Development & Marketing
CMO's Network Development Department manages the composition of provider networks. The Department tracks provider fluctuations and conducts analyses to determine network needs. Physician recruitment is aimed at maintaining a sufficient network of providers to meet regulatory requirements and enhancing both member and referring physician satisfaction Reporting and Measurement As a result of CMO's commitment to using care management and claims management software; financial reporting packages and electronic communications, providers supported by CMO can create numerous management reports to track productivity and manage cost.
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