How many lives do you cover?
Our current enrollment is 23,000 lives.
How do we access your services?
Whether you are an
employer, consultant, broker, or TPA you may call us directly to find out more
about our services. Our Sales Department is ready to assist you in
tailoring a network that meets the needs of your employees and your budget.
Call 217-222-9157 ext. 5130.
What is your network called?
QHCM owns and operates River Quest Network offering extensive coverage in the region.
How many providers are in your
network?
We have 65 hospitals and 6500
physicians .
Where are these
providers located
?
Our
providers are
located in Illinois, Missouri, and Iowa.
Other than network access, what services do you
provide?
In addition to a wide selection of providers, River Quest
Network offers claims repricing. In
addition, QHCM contracts with a pharmacy benefits manager, RxAmerica
. QHCM helps the employer offer a complete benefit package to their
employees.
What is your turn-around time for
repricing?
With the installation of a
new software system, QHCM has undergone quality initiatives and developed
standards of performance for data entry (<3 calendar days),adjudication (<1.7
calendar days),
and accuracy(>98%). Over the past several years, our claims department has
met
or
exceeded goals in at least two categories each month. Our current performance
is at 2.4
days for data entry;
1.3 days for adjudication; and >99% accuracy.
What is required on the employer ID
cards?
QHCM requires our network logo, River
Quest Network, along with our mailing address to appear on the ID card that the
employer distributes to their
employees. All of this information is provided during implementation of a
new client.
Are QHCM database systems HIPAA compliant?
QHCM can receive claims
electronically. Our current rate of electronic receipt from providers is 83%
of submitted claims via WebMD.
By mid year 2007 we expect to be able to receive and transmit claims in a HIPAA
837 compliant format, receive eligibility in HIPAA 834 format, and receive
and
transmit authorizations and referrals in HIPAA 278 format.
What regular reports are available?
