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Provider Villa

Provider Villa is a comprehensive solution that caters to provider integration needs of health plans and their operational processes. It is a central repository of provider and facility data which can be shared according to needs of different processes.

Why our Provider Villa solution is preferred by Health Plans

Single source of truth

Single source of truth for provider related information

Solves routine needs through real time accurate information from dependent systems

Providers can self-register into the application with valid TIN and NPI combinations

Admins can easily manage user accounts in the Provider Portal

Standard and Adhoc reports for audit purposes and insights

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Why our Provider Villa solution is preferred by Health Plans

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Single source of truth

Single source of truth for provider related information

Real time integration

Solves routine needs through real time accurate information from dependent systems

Provider self-registration

Providers can self-register into the application with valid TIN and NPI combinations

User account administration

Admins can easily manage user accounts in the Provider Portal

Reports for insights

Standard and Adhoc reports for audit purposes and insights

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Features at a glance

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Add Vendor with 1099, Pay-to address details, notes, contacts, attaching supporting documents, adverse actions etc

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Add Contract for “In network” providers at office location & for a time period. Creation of contract with Payclass, CPT and rev code-based exceptions for claims processing. Ability to capture interest rates, time limit for recoupment

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User can add multiple contracts and each contract information should be unique on the basis of below combinations:
Mandatory  : TAXONOMY+NPI + TAXID+PAR or NONPAR
Optional      : IPA+ PRACTICE LOCATIONS

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Add Provider details with address validations through smarty street, NPI validations with NPI registry, degree, provider type (PCP/ specialist/Mid Level Practitioner), location details with dates, linking of contract with providers and vendors, alias information

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Generation of unique Plan Provider ID if missing in migration

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Send the daily report to users after migration (for auditing)

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Add facility (hospital) details with tax id being common ID across multiple NPI’s

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Capture basic details of non-par providers but without contracts

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Search Provider on criteria like First Name, Last Name, NPI, Tax ID, Provider ID, PlanProviderID, Provider Type, Contract Status

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Search Contract on basis of Contract ID, Contract Name and Pay To

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Search vendor on basis of Tax ID/SSN, ID, Legal Name, Address, Pay to ID, Pay to Name, Payment System status

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Load Vendors File for bulk vendor & Pay-to creation

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Approval Queues for approving uploaded 1099/ Pay to Address

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File Tracker to keep track of files uploaded

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API’s to provide information to following systems:

Enrollment system for mapping members to PCP

Claims Adjudication system for claims processing

Utilization Management system for creating Pre auth for members

Customer service management / Provider portal

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Manage roles, users and mapping of users to role

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Standard and Adhoc reports for audit purposes and insights

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Search degree from list of created degrees

Why choose MIRRA's® Provider Villa Solution?

Mirra’s Provider Villa is designed as one-stop solution to provide access to providers for member’s benefits, eligibility, claim and payment status as well as prior authorization information. Self-service capabilities improves the efficiencies and satisfaction for providers, lowers the inquiries into the member services team, and increases the timeliness for authorizations, referrals, and appeals processing.

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Reviews & Testimonials

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NANCY GAREAUCEO of Ultimate Health Plans

"In 2021, Ultimate Health Plans (UHP) partnered with Mirra Health Care (Mirra) to develop a software platform to support processing Claims, Customer Service, Eligibility, Enrollment, Premium Billing, Encounter Processing and a Provider Portal for our Medicare Advantage Plans. Mirra collaborated well with our operations and compliance teams to successfully design and implement a system that was innovative, efficient, and compliant with all Medicare and Florida Medicaid guidelines and requirements all within the scope of our required timeline. We greatly benefitted from the Mirra Project Management Team’s regular communication with Stakeholders through monthly meetings and recurring weekly breakout-focused calls, which were geared towards troubleshooting and goal alignment. Mirra was able to quickly maneuver and adapt their systems to our needs, resulting in successful implementation and go-live. Mirra continues to support our compliant operation and growth in the ever-changing healthcare industry rapidly and effectively updating their systems with new Medicare and Florida Medicaid rates and guidelines to ensure seamless compliance and efficiency. I have absolutely no reservation in recommending their systems to any Payer searching for improvement in their operational efficiency."

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