Our first step was to assess and analyze the existing infrastructure and lay out a plan for managing the program moving forward to better serve the members. Karna employs a continuous improvement methodology to evolve WTC Health Program systems and services toward federal health program and commercial TPA best practices.
As part of our overall solution, we manage and staff member services systems to process member enrollment applications and medical condition certification requests. This work supports NIOSH determinations of beneficiary enrollment and benefit plan eligibility based on an individual’s exposures during and following the September 11, 2001, attacks.
We continue to develop and manage the program’s network of participating providers who perform screening, diagnostic, and treatment services to the member population in the greater New York metropolitan area. To keep the providers current, we train and support providers in new WTC Health Program policies and procedures, including coverage determinations, medical coding, and claims submissions.
Our medical management team provides recommendations for health plan policy, codebook management services, and medical claims review services.
Additionally, we provide systems infrastructure, services, and staff to support receipt, adjudication, and reconciliation of medical claims.
We also host and maintain the claims infrastructure, as well as provide centralized call center and mailroom services to support the Program. Our claims processing services include fraud waste and abuse, medical and pharmacy claims payment, and secure information maintenance and exchange.
We work hand in hand with our sister Celerian Group company, Palmetto GBA, to ensure all processes work across the various services we provide. Karna and Palmetto GBA implemented a streamlined solution to enroll providers based on Medicare enrollment requirements and created a WTC Health Program web portal for prospective providers to register with the Program, and to review and agree to the Program’s terms and conditions.