National Association of Rural Health Clinics [ Medicare Advantage Plan ]

Established in 1958, Sterling Life Insurance Company is dedicated to providing a variety of affordable healthcare solutions to Medicare beneficiaries.

Sterling was the first insurer in the country (June 2000) to successfully contract with the Centers for Medicare & Medicaid Services (CMS) for a newly-authorized product, Private Fee-for-Service (PFFS). By incorporating this plan into its already established Standard Medicare and Medicare Select insurance plans, Sterling became the first to offer this mix of products in one platform.

Today Sterling is licensed in 50 states, plus Washington, D.C., and has sales offices nationwide. Sterling has over 500 employees in its home office located in Bellingham, Washington, and about 400 field sales professionals across the country.

Sterling’s product line continues to grow and now consists of Medicare Supplement, Medicare Advantage Private Fee-for-Service and PPO plans and Medicare Part D Prescription Drug plans, along with life, long term care and critical condition/cancer insurance.

Provider Education and Outreach

Sterling maintains a provider outreach function providing routine communication to key providers, identifying concerns, updating plan terms and conditions, answering any questions the providers may have and responding to any critical areas of concern.

Prior to entering new markets or expanding service areas, Sterling’s Network Delivery staff completes the following:

· Call and send introductory education packet to all hospitals in service area; provide detailed overview via face-to-face visit or via teleconference;

· Identify major physician clinics and practices and establish physician relationships; mail all physician specialties in service area an overview brochure on plan offerings;

· Conduct orientation sessions to physician office managers and appropriate hospital staff.

Physicians identified by new members via the enrollment application are sent plan-specific information to prepare them for the enrollee’s transition to a new health plan.

Sterling’s website features a provider-friendly, comprehensive on-line provider manual as well as a fully-featured provider web portal to help providers streamline their claims and eligibility inquiries and track electronic claims payments.

Excellence in Reimbursement Methodology and Responsiveness

· Sterling maintains a provider dispute resolution process with robust policies, procedures and oversight to ensure that provider payment disputes are handled in a timely and responsive manner.

· Hospital Base Rate payment updates are updated within 48 hours of receipt from Fiscal Intermediary or Hospital and mirrors the effective date as stated by CMS.

o Sterling meets or exceeds CMS guidelines for timely processing of claims.

· Sterling consistently meets or exceeds the CMS benchmark of paying clean claims within 30 days (CMS requirement is 95%). The average turn-around time for claims is just seven days and 100% of all claims are processed within 60 days.

Quality Assurance and Tracking

Various data are tracked in order to monitor provider satisfaction:

· Reasons why providers choose not to accept Sterling plans

· Quantification of provider acceptance issues through enrollee satisfaction surveys; review of complaints, grievance & appeals, and complaints

· Provider Satisfaction surveys

To learn more about Sterling, visit our website SterlingPlans.com.