County of Kern Point of Service Plan County of Kern Health Care Network Burns Consulting Associates Clinix Healthcare Zenith American Solutions
Point of Service Benefit Still the same POS Plan... • Member benefits are not changing • Services requiring authorizations are not changing changing • Eligibility is not changing (you will see the same patients) • Plan document is being updated for ACA
Network Administration The County has established an independent governmental trust to hold all contracts. Burns Consulting Associates is providing network administration services for the new network administration services for the new Kern Health Care Network trust. Contract-related provider issues will be handled by Burns.
Utilization Management Clinix Healthcare will be providing utilization management services, including referrals and authorizations. You can submit and review authorization or You can submit and review authorization or pre-certification requests at Clinix online portal through www.kernpos.com/providers .
Claims Administration Zenith American Solutions will be the claims administrator for the POS Plan. Claims can be submitted electronically or via mail to the local Bakersfield office. mail to the local Bakersfield office. You will be able to access claims information and print EOBs at the Zenith online portal through www.kernpos.com/providers .
Transition “Cut-Over” • MCS will cease accepting claims as of 9/20 • MCS is issuing authorizations with term of 9/30 • Clinix will honor authorizations for 90 days • Clinix will honor authorizations for 90 days • 9/23 Clinix begins issuing authorizations • Members are covered beyond 9/30 • “Run-in” claims not yet paid by MCS will be paid by Zenith
Contact County of Kern Point of Service Plan 4700 Stockdale Highway, Suite 140 Bakersfield CA 93309 Toll free: 1 (855) KERN POS Local: 868-3166 www.kernpos.com
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