The Managed Care Department at Springfield Clinic provides the interface between health insurance companies, Springfield Clinic's network of providers and our patients.
Our primary role is to manage the in-network insurance contracts for the organization and to make certain all providers are enrolled properly. As part of that process, we manage all provider credentialing, including the confirmation of education, training and certifications. Our staff provides rigorous scrutiny of provider documents to ensure the highest level of quality and accuracy of physician information. We collaborate with Springfield Clinic's Quality Management Department to verify appropriate continuing medical education and training is completed as prescribed. We are responsible for coordinating all appropriate licenses required by regulatory and governmental agencies and arrange for privileges at numerous hospitals throughout the central Illinois area.
While many of these services may focus on service to physicians and the medical community, we ultimately serve Springfield Clinic patients, by ensuring quality and safety of care that comes from thorough and accurate credentialing processes.
Looking for a National Provider Identifier (NPI) number?
Please contact our Managed Care Department or visit the national registry.
Health Maintenance Organization (HMO): HMOs offer prepaid, comprehensive health coverage for both hospital and physician services. An HMO contracts with health care providers, e.g., physicians, hospitals, and other health professionals, and members are required to use participating providers for all health services. Members are enrolled for a specified period of time. Model types include staff, group practice, network, and IPA.
Preferred Provider Organization (PPO): Some combination of hospitals and physicians that agrees to render particular services to a group of people, perhaps under contract with a private insurer. The services may be furnished at discounted rates and the insured population may incur out-of-pocket expenses for covered services received outside the PPO if the outside charge exceeds the PPO payment rate.
Point-of-Service (POS): Also known as an open-ended HMO, POS plans encourage, but do not require, members to choose a primary care physician. As in traditional HMOs, the primary care physician acts as a "gatekeeper" when making referrals; plan members may, however, opt to visit non-network providers at their discretion. Subscribers choosing not to use the primary care physician must pay higher deductibles and copays than those using network physicians.
Workers Compensation: A state-mandated program providing insurance coverage for work-related injuries and disabilities.