Office of Managed Care

Who We Are

Gregory Kile
Executive Director and CEO
610-969-0146
gregory.kile@lvh.com

Services

In order to be responsive to our network providers and our managed care partners, the Lehigh Valley Physician Hospital Organization’s Office of Managed Care offers the following services:

Managed Care Contract Negotiation

• Review and analyze contract terms.
• Act as liaison between hospital and payers.
• Support network-wide effort to improve contract performance and increase actual/expected revenue.
• Promote clinical programs to payers and other referral sources.
• Negotiate with case managers, insurers, reinsurers, managed care organizations and self-pay clients providing for a single point of contact.
• Coordinate contracting activity with payers, networks and reinsurers, including review and impact analysis.

Contract Management and Implementation

• Maintain and manage all Lehigh Valley Hospital and Lehigh Valley Hospital - Muhlenberg managed care contracts.
• Coordinate contract implementations.
• Facilitate training programs for physicians, administrators, case managers and practice management staff regarding managed care contracts.

Management of Lithotripsy Global Agreement

• The Office of Managed Care manages the agreement between the Lehigh Valley Hospital and Independence Blue Cross, Keystone Health Plan East, and Capital Blue Cross. The process involves Urology practices sending HCFA 1500 claims to the Office of Managed Care for payment.

Contract Compliance Audits and Payment Reimbursement Monitoring

• Provide periodic reimbursement audits for Lehigh Valley Hospital and Lehigh Valley Hospital - Muhlenberg claims.
• Access contract performance data, identify specific revenue enhancement opportunities and renegotiate contracts to promote improved contract performance.

Fee Schedule

• Maintain Valley Preferred Fee Schedule
• Annual review - presentation to Contract Negotiation Committee
• Provide specific fee review requests