• Critical tools to help evaluate provider contracting efficiency using claims data and operations as inputs, also known as network optimization
  
  
• How payors can provide transparency for claims status to alleviate providers’ biggest challenges to resolve claims and the sourcing of edits used to process claims
  
  
• The ability on the provider side to implement the same edits in a way that they would be used by the provider’s billing system to create claims that are specifically coded and formatted for the specific player

Health Plans:
• Chief Information Officers
• Managers, e-Business Services
• Managers, Provider Relations
• Managers, Claims Operations

Providers:
• Controllers
• Directors, Patient Accounts
• Directors, Managed Care
• Directors, Revenue Cycle Management

Michael O'Shea is Manager of Provider Relations, responsible for relationship management and operational support of the eastern Massachusetts provider network. He supports key integrated delivery systems, academic medical centers and tertiary providers that are the backbone of the Harvard Pilgrim network through ongoing consultation, training and education on the company's policies and procedures. He developed, implemented and manages Harvard Pilgrim's efforts to reduce administrative denials within the provider network. In the first six months of the department's efforts in 2004, Harvard Pilgrim realized a 12 percent decline in measured denials. In 2005, provider relations consultants visited more than 2,200 targeted provider sites promoting provider best practices that resulted in a further 23 percent reduction in key denial areas when compared to 2004. His contributions to corporate administrative simplification efforts include consultation on overall provider strategies and implementation of initiatives that positively impact the provider experience. Prior to joining Harvard Pilgrim in 1998, Mr. O'Shea was a practice administrator with Puritan Medical Center, a thirteen physician, multi-specialty group in Salem, Massachusetts. He was responsible for all daily practice operations and financial planning and analysis. Mr. O'Shea has a BA in Political Science from Villanova University. He is an active member of the Medical Group Management Association.

Roy Sailor is responsible for the Payer Market for Ingenix, driving development and deployment of products and services that help health plans improve integrity of claims payments. He has over 20 years of progressive experience in developing health plan IT strategy, designing and implementing core administrative systems technology, and managing claims processing operations. Before joining Ingenix, Mr. Sailor served as CEO for the DIAMOND Solutions Group at Perot Systems Corporation which provides core administrative systems for over 60 health plans worldwide. He held senior leadership positions with First Consulting Group and was Vice President of Operations for Nichols TXEN, a provider of ASP managed care systems and BPO services. Sailor is active in several industry trade groups such as the Managed Care Executive Group, has been a contributing author to numerous trade articles, and serves on the advisory board of the eHealth Initiative newsletter. He holds a Masters of Science degree in Computer Information Systems from Colorado State University and a Bachelor of Arts degree in Business Administration from Fort Lewis College in Durango, Colorado.

Rhonda Starkey is Manager, Provider e-Business Services, responsible for provider adoption of all e-transactions and provider authorization, service, satisfaction and support of provider web platform at Harvard Pilgrim Health Care. In this position, she is the adoption lead of the Channel Strategy Core Team, developing strategy, tactics and goals for marketing, sales, service and new product development for provider e-transactions across four portals. Before her current role, she was a provider relations manager acting as provider business lead for three corporate turn-around initiatives, responsible for provider service for ancillary, DME and individual contracted providers in four states. She has also served as NH Operations Manager and key regional operations liaison with all Harvard Pilgrim “core” support services in Massachusetts, responsible for referral/authorization intake, claims problem resolution, member concerns, and provider and member services for New Hampshire members and provider network. While with HPHC, Ms. Starkey has been recognized with several awards: Excellence in Project Management Award, The Director’s Soar with Eagles Award, and the Staff Achievement Award. Before joining HPHC, she was with Healthsource Massachusetts, Inc., directing hospital and ancillary provider services cost containment and strategic network development. Prior to working in health plan organizations, Ms. Starkey was with Atlantic Medical Center, directing managed care operations for 30 individual plans. She also worked with Westmoreland Health System, managing the $2.5 million ambulatory surgery project from product research and design through construction. Ms. Starkey has a MBA from the University of Pittsburgh and a Bachelor of Science degree in Health Planning and Administration from The Pennsylvania State University. Ms. Starkey is active in the community as a volunteer at Crisafulli Elementary School and as a vice president on the board of directors for PROBE.

Julia Fairclough is the editorial director for Corporate Research Group and oversees CRG’s health information technology and specialty pharmacy markets via the monthly eHealth Insider newsletter, CRG Data Pak and Action Guides, books and audioconferences. She has over 15 years experience in the journalism and healthcare publishing industries.

Strategies for Achieving an Integrated Relationship Between Claims Operations and Provider Contracting Audioconference is sponsored by eHealth Insider. eHealth Insider – the newsletter for people who that a judicious investment in information can pay a many-fold return – is a complete intelligence service that offers tough talk about real contenders, mergers and acquisitions, IPOs, new ventures, and cockeyed business plans in the ever-evolving eHealth industry and the world of managed care IT. And the exciting news is that we just relaunched eHealth Insider to offer the inside scoop on the technological advances health plans are forgoing to speed up the EDI highway, as well as case studies on how businesses have implemented buisiness process applications to increase efficiencies. With weekly email updates and monthly newsletter, eHealth Insider also keeps you informed on new cutting-edge technologies relating to consumer driven healthcare. eHealth Insider is the solution to all your health information technology needs – to keep you in front of the competition. As a special bonus, registrants of the May 23 audioconference are eligible for a 20% discount off the eHealth Insider annual subscription. To receive your special discount, mention priority code: 25EHI052306.

The CRG Audioconferences are prepared by the editors of Corporate Research Group (CRG). Corporate Research Group has been serving the managed healthcare marketplace for over 14 years as the industry's leading source for breaking news, strategic intelligence, market research and custom consulting. CRG products consist of print and electronic newsletters, e-mail updates, annual forecasts, conferences, audioconferences, CD-Rom's and the unique Managed Care Access online information service.

If you have any questions, please contact Reena Joseph at Corporate Research Group at 914-235-6000.