Cahaba has established a reputation for excellence through our years in the federal government contracting space. We continue to seek improvements daily in all of our processes. Our exceptional work in the following functions has led us to become experts and we proudly offer these services to those seeking a partner with these skills.

 

Clinical Review

Cahaba’s Clinical Review Strategy, available as a stand-alone service, protects Medicare by eliminating the inappropriate spending of scarce program funds. With a focus on better care, Cahaba helps protect Medicare patients by preventing duplicate services and unnecessary tests and improving clinical guidelines for higher provider reimbursement. Through our key activities and risk mitigation strategies, we are able to successfully prioritize resources for maximum savings for the Medicare Trust fund.

  • Every $1 spent in Clinical Review for Medicare Part A saves $423 of the Medicare Trust Fund
  • Every $1 spent in Clinical Review for Medicare Part B saves $40 of the Medicare Trust Fund
  • Cahaba has surpassed national Comprehensive Error Rate Testing (CERT) rates for 3 years
 

Appeals

Cahaba’s dynamic partnership between our Claims and Medical Review departments, combined with a mature inventory management system, enables us to exceed customer requirements in processing appeals. In completing an appeal, multiple partners must be engaged frequently and efficiently to be successful. Cahaba has the qualified resources and tools necessary to exceed customer expectations.

 

Medicare Experience

Since the creation of the Medicare program, Cahaba has processed Medicare claims, including hospital (Part A), physician (Part B), durable medical equipment, and home health and hospice claims. From that experience, we have evolved an enterprise-wide automated system to manage claims, appeals, clinical reviews, customer service, financial management and operational excellence, all supported by ongoing innovation and related technology. Cahaba’s Comprehensive Error Rate Testing (CERT) score is consistently better than the national average.

As a subcontractor on the Benefits Coordination and Recovery Center (BCRC) contract, Cahaba also has years of experience performing debt collection and recovery of Medicare Trust Fund dollars for this national workload. As a subcontractor to the BCRC prime, Cahaba is responsible for actions and inquiries required to identify or initiate MAC or BCRC recoveries to an employer, insurer/Third Party Administrator (TPA), Worker’s Compensation carrier, no-fault insurer, liability insurer or Medicare beneficiary.

 

Partnering Opportunities

Cahaba looks to develop partner relationships with other companies that hold the highest ethical and quality standards and whose business capabilities supplement our strategic goals for growth.

Partner with Us

Current Contracts

Commerical Contracts

With years of Medicare Part A and Part B contract administration experience, Cahaba consults with companies interested in entering government health care to deliver first-hand knowledge of Medicare Administrative Contractor (MAC) requirements.  The government healthcare administration must be fluid to match the fast-paced changes in general healthcare.

Subcontractor for Benefits Coordination and Recovery Center (BCRC)

Cahaba is also a subcontractor to GDIT for the Benefits Coordination and Recovery Center (BCRC) contract. BCRC is responsible for all Non-Group Health Plan (NGHP) debt under the umbrella of the national Coordination of Benefits and Recovery Program (COB&R). Cahaba performs post-payment recovery activities for liability, workers’ compensation, product liability, and no-fault claims.

Government Healthcare Contracting Experience

Cahaba’s long history as a Medicare claims processor has led to expertise in the administration of government contracted healthcare. Cahaba performs the following major functions as the Jurisdiction J A/B MAC:

  • Claims Processing
  • Provider Customer Service
  • Appeals
  • Provider Education
  • Medical Review
  • Provider Enrollment
  • Audit
  • Reimbursement
  • Overpayment Recovery
  • Medicare Secondary Payer (MSP)

Integrity is at the heart of all we do. Our goal is to provide the highest quality service to all our customers, and to do so while maintaining the highest ethical standards. We have been ISO 9001-2008 certified since 2007. In 2011, Cahaba became the first MAC to have its Compliance Program certified by the Health Ethics Trust, and recently completed its first re-certification assessment.

ISO Certified and Compliance Certified by Health Ethics Trust.