ENSURING

PRIVACY AND INTEGRITY

Our services support some of the nation’s most critical health programs.

Through our dedication to innovation and emphasis on exceptional performance, we have built our reputation as a reliable steward of the federal health programs we manage. Our associates have some of the deepest knowledge in the industry for what it takes to successfully administer a federal health program. We are proud to perform work that positively impacts the health of millions nationwide.

Our areas of expertise include:

  • Enrolling new providers
  • Redeterminations on appeals of claims
  • Educating providers
  • Customer service in responding to telephone and written inquiries

What we offer our partners

Claims administration

As a core piece of National Government Services’ work, claims administration is where our federal government relationship began back in 1966. Since then, we’ve helped federal health reach many milestones. Our accomplishments include transitioning 98.9% of providers from paper to electronic claims, integrating with core customer claims systems, and developing a proprietary application that supports automation and efficiency gains.

Provider Contact Centers

We leverage the latest in technology while never losing sight of the value of human interaction. Highly-trained associates familiar with the intricacies of federal health programs help customers get the answers they need quickly.

Our provider contact center serves customers, providers and beneficiary communities by handling more than 1.5 million inquiries annually. Our self-service web-based portal is a valuable tool for 370,000 providers to access relevant information.

Fraud prevention services

It is our job to protect the integrity of some of federal health’s most prominent programs. Responsible for billions of dollars in the Medicare Trust Fund, we fight fraud, waste and abuse relentlessly by monitoring 6 million claims a day. These efforts have saved U.S. taxpayers’ millions of dollars and help preserved the Medicare Trust Fund for future generations.

Through advanced analytics, modeling and a team of highly qualified statisticians, we identify issues early and curtail them before they become costly. Working together, we helped the Center for Program Integrity (CPI) save over $800 million in its first three years of operation.

Business intelligence

Using data in smart ways helps National Government Services identify trends in claims, analyze appeals, develop medical review strategy, identify contact center call drivers and more. This kind of intelligent forecasting helps us proactively create efficiencies that streamline work processes while saving agencies’ money.

By developing sophisticated algorithms, we are able to flag providers for improper payments and suspected fraud, waste and abuse. In our unique position, we amalgamate valuable data relating to patient mix, claims payment summaries, top procedures billed, top diagnoses billed and top referring providers.

Provider outreach and education

With the frequent changes in our federal health care system, having a close relationship with our clients is invaluable to remaining on the front line of the evolving rules and regulations that must be adhered to for successful program execution. National Government Services draws upon our close customer relationships and deep domain experience to develop education and outreach programs for the medical community.

We provide enrollment, education and information updates for more than 370,000 providers. Our Medical Review clinicians work side-by-side with physicians to decrease Medicare denials through proactive outreach and education, and we work with physicians to streamline processes to reduce red tape.

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