Commitment to Providers

Guardian Healthcare embraces the concept of establishing a strong partnership with healthcare providers. We know that this partnership requires us to continually demonstrate a willingness to communicate with and educate our provider partners about Guardian Healthcare operations, and provide providers with efficient and effective avenues for addressing provider issues and concerns. Accordingly, Guardian Healthcare is committed to: 

Provider Relations

• Having a Provider Relations Field Representative in your county available to meet face-to-face with staff to answer questions and provide in-service opportunities; and,

• Having exceptionally trained Physician/Provider Service Representatives available by telephone to answer questions, provide claims status, and resolve problems during regular business hours.

Claims Payment

• Paying “clean claims” as defined by Prompt Payment Guidelines – 15 days for submissions via EDI and 30 days for submissions via paper;

• Assisting physicians/providers to submit claims for payment via electronic format (EDI) for purposes of efficiency, tracking, and improved payment turnaround; and,

• Assisting physicians/providers in posting claims to their accounts receivable through designing an easy-to-use Explanation of Benefits (EOB).

Medical Management

• No imposition of the need for referrals or authorizations.

• Developing and implementing state-of-the-art health risk management, disease management, and wellness programs to assist our physicians/providers to provide the highest quality of care to their patients and to ensure the highest quality of life for their patients.

Technology:

• Selecting and operating state-of-the-art software IT platforms for claims processing, enrollment management, member services, and information analysis;

• Utilizing “web portals” for physicians/providers that allows them to interact with the Plan database in accessing information regarding claims payment status, and,

• Designing and maintaining a website whose goal is to provide up-to-date information about Plan benefit design, upcoming physician/provider educational programs, updates on disease management initiatives, opportunities to participate in surveys, and much more.

Customer Service

• Provision of high-quality service and open access communication to Guardian providers and members; 

• Outstanding Upstate South Carolina-based telephone customer service;

• Cutting-edge web access; and
  
  
• Hire the most highly qualified staff and a commitment to training within our capabilities.