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Product Highlights

Essential Benefits Administration Services

Claims Administration

CrestPoint Health provides fully compliant and timely claims processing services to its customers,acting efficiently with a high level of customer service and advance reporting tools.

Utilization Management

CrestPoint Health’s utilization management review process ensures a patient’s hospital stay, surgery, tests or other treatment is required and necessary.

Quality Management

CrestPoint Health maintains Quality Management (QM) programs that continually evaluate, monitor and improve the quality of care provided to its client members. CrestPoint Health coordinates with affiliated physicians, health plans and ancillary providers to improve the quality of care. We employ a Quality Management team to oversee internal quality initiatives, facilitate reporting and conduct provider credentialing and site reviews.

A Strong Network of Quality Providers

Credentialing

CrestPoint Health credentials every physician provider under contract – excluding hospital-based physicians, who are re-credentialed every three years. CrestPoint Health works with Integrated Solutions Health Network (ISHN). ISHN is in the process of becoming an NCQA-accredited credentialing verification organization in order to help meet the highest credentialing standards for its customers.

Provider Contracting and Recruiting

We offer a comprehensive network by contracting with local, regional and national provider networks. CrestPoint Health, in partnership with Integrated Solutions Health Network (ISHN), contracts and recruits the services of physicians, specialists, ancillaries and hospitals. CrestPoint Health provides a national network for health care services via the Multiplan and Private Health Care Services (PHCS) networks.

HIPAA Compliant Programs

HIPAA Compliance

CrestPoint Health and its affiliates have been diligently following the evolution of the administrative simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) since its inception in 1996. CrestPoint Health’s goal is to ensure the company’s systems, supporting business processes, policies, and procedures can successfully meet the implementation standards and deadlines mandated by the United States Department of Health and Human Services (DHHS).

CrestPoint Health helps its customers migrate to the new HIPAA standards without creating unnecessary administrative burdens or causing significant disruptions in health care payments and services.

Many Other Services

Eligibility Processing

CrestPoint Health receives and processes eligibility data in a standard HIPAA 834 format.

Financial Management

CrestPoint Health ensures success for its customers through management reporting, as well as finance and accounting activities.

Management Reporting

CrestPoint Health offers its customers extensive and tailored management reports. The goal is to provide customers with the tools necessary to make the right decisions.

Medical Management

Through turn-key Medical Management, CrestPoint Health ensures quality of care and cost management through prior authorization, case management, concurrent review, discharge planning and follow-up assessment.

Reinsurance and Underwriting

Collaborating with several reinsurance carriers, we provide access to competitive levels of stop-loss coverage.

Other Insurance Services

Stop Loss
Third-Party Liability (TPL)
Coordination of Benefits (COB)

Strong Communications and Customer Service

Customer Service

CrestPoint Health’s primary focus is serving our customers. By offering extended hours, member advocates, online enrollment and claims access, and more – we emphasize our commitment to customer care.

Communications

It is imperative that members are able to understand their health plan benefits. We offer simple, concise, and easy to understand materials to communicate in straightforward terms.

CrestPoint Health’s ultimate goal is to deliver happiness to the mind, body and spirit of our members.

We deliver this by being customer-focused in everything we do and with everyone we serve. We accept personal responsibility for achieving better results, and embody ethics, pride, integrity, and passion in all we do. CrestPoint Health serves as an advocate and leader in the delivery of exceptional health care. Through creative and innovative solutions, we investigate and discover ways to work faster, simpler, and smarter. We recognize that it is important to listen to others and maintain a level of mutual respect, as we strive to collaborate with our partners and community to achieve better well-being.

CrestPoint Health is committed to controlling health-related costs while focusing on health & wellness. Choose the right combination of any of our Health & Wellness Services