PCH provides centralized administrative support for daily practice operations. This includes maintaining payer demographics, network participation records, and provider rosters.
Our team manages demographic updates, payer documents, participation checks, and coordinates with health plans on operational and non-clinical compliance issues.
PCH gives access to MSO-level reporting dashboards that improve operational visibility and help track performance.
Reporting tools may include:
PCH handles the non-clinical parts of Remote Patient Monitoring programs.
Administrative services include:
PCH also prepares billing support documents summarizing device use and monitoring activity, which are required for CPT codes 99453, 99454, 99457, and 99458.
Providers who participate gain access to PCH’s proprietary administrative infrastructure, which includes:
PCH provides administrative infrastructure for Chronic Care Management programs in accordance with CMS guidelines.
Administrative services include:
PCH handles ongoing communication between providers and participating health plans.
This includes sending payer bulletins, regulatory notices, compliance deadlines, network announcements, and delegated-function requirements. Providers receive regular updates and coordinated messages to stay informed and aligned with payer expectations.
PCH provides guidance to providers on non-clinical compliance, including payer operational rules and administrative regulations. This includes:
PCH handles the administrative preparation, submission, and tracking of payer credentialing and enrollment applications for participating providers.
Services include:
PCH supports providers running Medicare- and CMS-recognized care management programs by providing the administrative infrastructure needed to operate them.
PCH assists providers with administrative marketing coordination to support operational communication and public information management.
Services may include:
PCH provides centralized administrative support for daily practice operations. This includes maintaining payer demographics, network participation records, and provider rosters. Our team manages demographic updates, payer documents, participation checks, and coordinates with health plans on operational and non-clinical compliance issues.
Exclusions
* Clinical credentialing file preparation is an optional service unless elected
* Prior authorizations, claims submission, or appeals
* Negotiation of payer contracts or reimbursement rates
* Guarantees of acceptance into any payer network
PCH handles ongoing communication between providers and participating health plans.
This includes sending payer bulletins, regulatory notices, compliance deadlines, network announcements, and delegated-function requirements. Providers receive regular updates and coordinated messages to stay informed and aligned with payer expectations.
Exclusions
* Patient communications or outreach messaging
* Health plan marketing or plan-selection guidance
* Medical advice or clinical guidance
PCH gives access to MSO-level reporting dashboards that improve operational visibility and help track performance.
Reporting tools may include:
* Provider attribution and roster analytics
* Basic utilization summaries
* Network status reporting
* Quality indicator summaries
* Operational performance measures
Regular review meetings help practices evaluate trends and identify opportunities to improve operations.
Exclusions
* Custom analytics or advanced BI tools
* Risk adjustment modeling or revenue forecasting
* Medical decision-support analytics
* Clinical quality program design, unless elected separately
PCH provides guidance to providers on non-clinical compliance, including payer operational rules and administrative regulations.
This includes:
* Roster accuracy monitoring
* Documentation standards for payer submissions
* Network adequacy requirements
* Help with responding to routine compliance inquiries or administrative audits
Our goal is to help providers meet payer administrative expectations and reduce operational risks.
Exclusions
* Legal interpretation of regulations
* Replacement for legal counsel
* Responsibility for clinical documentation as well as coding compliance
* Guarantee of regulatory or audit outcomes
Providers who participate gain access to PCH’s proprietary administrative infrastructure, which includes:
* MSO reporting dashboards
* Operational analytics systems
* Provider portals
* Ticketing and support systems
* Operational coordination resources
These tools support Traditional Management Services and increase operational visibility for participating practices.
Exclusions
* EMR/EHR or practice management system licenses
* IT support for provider hardware or internal systems
* Custom system integrations, unless separately elected
* Premium systems reserved for Value-Based Care or RCM services
Once providers have system access, we explain our credentialing and enrollment support.
PCH handles the administrative preparation, submission, and tracking of payer credentialing and enrollment applications for participating providers.
Services include:
* Collection of provider documentation
* Completion of payer-specific applications
* CAQH profile maintenance
* Submission tracking and follow-up
* Monitoring application status and expected effective dates
* Provider directory accuracy and correction management
PCH stays in regular contact with payer organizations to manage information requests and support the credentialing process.
Exclusions
* Guarantee of payer approval
* Influence over payer enrollment decisions
* Facility privileging or peer review
* Clinical credentialing functions
PCH supports providers running Medicare- and CMS-recognized care management programs by providing the administrative infrastructure needed to operate them.
PCH handles the non-clinical parts of Remote Patient Monitoring programs.
Administrative services include:
* Patient eligibility verification
* Coordination of device distribution with RPM vendors
* Patient onboarding support
* Device connectivity oversight
* Monitoring dashboard management
* Identification of data transmission gaps
* Escalation of clinically significant data patterns to provider clinical teams
PCH also prepares billing support documents summarizing device use and monitoring activity, which are required for CPT codes 99453, 99454, 99457, and 99458.
Exclusions
* Clinical monitoring of patients
* Clinical interpretation of patient data
* Medical triage or patient care
* Procurement or selection of medical devices
PCH provides administrative infrastructure for Chronic Care Management programs in accordance with CMS guidelines.
Administrative services include:
* Patient eligibility list maintenance
* Patient enrollment and consent coordination
* Monthly time tracking for CCM billing requirements
* Administrative documentation management
* Care plan document maintenance provided by the provider
* Monthly program documentation packets for billing support
Performance reports also provide information about patient engagement and participation trends.
Exclusions
* Clinical care plan creation or modification
* Clinical assessments or interventions
* Determination of medical necessity
* Clinical patient outreach
PCH assists providers with administrative marketing coordination to support operational communication and public information management.
Services may include:
* Development of non-clinical marketing materials
* Website and digital communications support
* Directory listings management
* Social media coordination
* Practice announcements and operational communications
* Event coordination support
All activities focus on non-clinical, non-promotional communications and ensure compliance with healthcare regulations.
Exclusions
* Health plan marketing
* Insurance enrollment activities
* Patient steering or plan influence
* Sales or promotional outreach
A professional entity providing comprehensive management and administrative support to healthcare providers. We streamline non-clinical aspects of medical practices like billing, financial management, HR, and technology services to allow a focus on patient care and improving overall practice efficiency.
It allows you to reduce administrative burdens, improve cost-effectiveness, access specialized expertise, enhance patient satisfaction, and ensure compliance with industry regulations. Outsourcing non-core functions to PCH allows your team to devote more time and energy to delivering high-quality patient care.
Yes, PCH provides ongoing training, robust system implementation, vigorous audits and expert guidance to effectively mitigate compliance risks.
Absolutely! PCH significantly enhances revenue cycle management through efficient billing and coding practices, timely claims submission, and effective follow-up on unpaid claims. By identifying and addressing revenue leaks and inefficiencies, our management services optimize your financial performance to maximize medical practice revenue generation.