Ph:(626)943-7465 Fax:(626)458-8051

S&S Management, Inc.
Healthcare Management Services At Its Best

S&S Management, Inc. has been managing medical groups and independent practice associations for over 25 years.Through the use of advanced technology, leveraging of best practices and dedication to customer satisfaction, we take pride in meeting the business needs of our clients to ensure the delivery of quality, affordable healthcare.

ABOUT US

OUR COMPANY

Established in 1995 to provide business operations support to Stewart Medical Group, S&S Management Inc. developed a reputation for its stellar customer service, strong relationships with health plan partners, and ability to drive results. After being approached by physician organizations for our expertise and access to a full range of management services, S&S Management, Inc. clients include over 10000 physicians throughout Los Angeles, Orange and San Diego Counties.

OUR MISSION

S&S Management, Inc. strives to provide exceptional healthcare management services tailored to meet the needs of each Independent Physician Association and Medical Group we support so that together, we can deliver cost effective, high quality care and better outcomes to have a positive impact on the members we serve.



OUR SERVICES

CAPITATION

S&S Management, Inc. offers various options for processes monthly capitation payments for primary care and specialty providers. Capitation detail reports to support calculations accompany each payment. Membership and capitation payment information is also available on-demand for providers to access through our Provider Portal.

CASE MANAGEMENT

The S&S Management, Inc. Case Management team is comprised of RNs, LVNs and other support staff. We work closely with members, caregivers, physicians and health plans to create and manage treatment plans, coordinate healthcare services and connect members to resources available to keep them healthy and in the community.

CLAIMS OPERATIONS

The Claims Department ensures all claims are received are processed and paid correctly according to regulatory requirements. S&S Managment, Inc. encourages electronic claims submission from providers directly through the Provider Portal and Office Ally.


CONTRACTING/PROVIDER RELATIONS

S&S Management, Inc. has a team of professionals who are knowledgeable in various reimbursement methodologies and experience negotiating managed care contracts with payors and providers. They are able to resolve escalated issues, build networks as well as support physicians through education and training.

CREDENTIALING

S&S Management, Inc. handles all credentialing and recredentialing of providers for its clients according to NCQA requirements. Upon verification of all credentialing information, providers are presented to the Credentialing Committee on a monthly basis, and as needed, to review and approve files. S&S Management, Inc. provides ongoing monitoring of practitioner sanctions, complaints and quality issues.

ELIGIBLITY AND BENEFITS

Participating providers are able to access member eligibility information through the Provider Portal. Eligibility is updated on a daily, weekly or monthly based on the time/frequency the information is received from health plans. Prior to posting eligibility data into the Provider Portal, S&S Management, Inc. reconciles the information to ensures its accuracy.


FINANCIAL ANALYSIS & REPORTING

In addition to preparing and submitting financial reports to meet regulatory and health plan requirements, S&S Management, Inc. provides its clients with various reports which include key metrics to monitor and track performance, identify opportunities for revenue, improve quality of care, lower costs and to help drive strategic decisions.
Robust audit processes are in place to ensure data integrity. Reconciliations are regularly performed on all incoming revenue and outgoing payments.

HEDIS/RISK ADJUSTMENT

S&S Management, Inc. has a team of HEDIS and Risk Adjustment Specialists who work closely with providers year-round on risk adjustment coding and HEDIS initiatives. The team facilitates completion of annual well visits, leads interventions, conducts chart reviews and administers provider incentives to promote quality health care services.

QUALITY MANAGEMENT

S&S Management, Inc. has a Quality Management Program to evaluate, monitor and ensure that all members are able to access quality health care services and receive stellar customer service. S&S Management continuously reviews and monitors data such as, but not limited to, complaints, grievances, sentinel events, claims, authorizations to identify opportunities for improvement.


UTILIZATION MANAGEMENT

The Utilization Management team is comprised of clinical staff, including Medical Directors and physician reviewers. As service requests are received, the team applies clinical guidelines to ensure the delivery of quality health care services to members in the most appropriate setting.
The Provider Portal is available for participating providers to submit service requests. The system allows providers to submit supporting medical notes and other information needed for clinical review.

TECHNOLOGY

Technology is critical to effective and efficient healthcare management services. S&S Management, Inc. uses MSO Exec, a web-based proprietary system, for core functions such as claims, eligibility, authorizations, etc. A Provider Portal is available for participating providers. Portal access and training is available for new providers and as requested.

CUSTOMER SERVICE

There are knowledgeable customer service representatives available to assist members, providers and other callers during business hours. Callers may be routed to different departments for further assistance, if needed. Messages received are responded to within 24-28 hours of receipt.

MANAGED IPAs

Advanced Medical Doctors of California

Advanced Medical Doctors of California (AMDC) is comprised of a group of independent physicians who are dedicated to improving the health and well-being of seniors. With a robust network of primary care physicians and specialists in the San Gabriel Valley area of Los Angeles County, AMDC is committed to servicing patients with the highest standards in medical care through providing the most comprehensive services that managed care has to offer.

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American West Healthcare Solutions

Our network of multilingual physicians knows not just your language, but the ways you want to be treated. We pay attention so we can deliver the preventative, specialty, and mental health care you deserve, plus patient education that can help keep your whole family healthier. ​ As an AWHS member, you’ll have access to a team committed to addressing everything that impacts your health and wellness.

DETAIL

Doctor's Managed IPA

Doctor's Managed IPA has been providing compassionate, high quality healthcare to the seniors. Helping physicians maximize revenue without compromising quality of care, Doctor's Managed IPA continues to advocate to meet the needs of both its providers and patients alike.


Evergreen IPA

Evergreen IPA is multicultural network of independent physicians who specialize in caring for seniors residing in Los Angeles and Orange Counties. The group is committed to the delivery of exceptional care and providing outstanding customer service to its patients.

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Stewart Medical Group

Stewart Medical Group has been providing compassionate, high quality healthcare to the seniors in the San Gabriel Valley of Los Angeles County for over 25 years. Helping physicians maximize revenue without compromising quality of care, Stewart Medical Group continues to advocate to meet the needs of both its providers and patients alike.

DETAIL

United Physicians International

United Physicians International, Inc. (UPI) was founded by a group of independent physicians who shared a common vision: seniors deserve healthcare of the highest quality. With a goal of providing safe and effective medical treatment in a compassionate and culturally sensitive manner, UPI and its network of physicians care for seniors throughout Los Angeles and San Diego Counties.

DETAIL

YOUnity Medical Affiliates

YOUnity Medical Affiliates is a network of Primary Care Physicians and Specialists known as an IPA (Independent Physician Association). These dedicated physicians have served the area communities for more than 20 years. With the faithful following of its patients is a testimony to the trust developed through the years. Comprised of family, general and internal medicine practitioners, the structure and mission of YOUnity IPA are to address the prevailing needs of the ever-growing senior Medicare and Dual Eligible (Medi-Medi) retirees these doctors have been serving.

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HEALTH PLANS

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Alignment Health Plan

Members: 1-866-634-2247

Providers: 1-844-361-4712

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Astiva Health

Members: 1-866-688-9021

Providers: 1-866-688-9021

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Blue Shield Promise Health Plan

Members: 1-800-424-6521

Providers: 1-800-424-6521

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Brand New Day Health Plan

Members: 1-866-255-4795

Providers: 1-866-255-4795

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Central Health Plan

Members: 1-866-314-2427

Providers: 1-626-388-2390

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Clever Care Health Plan

Members: 1-833-365-1888

Providers: 1-833-388-8168

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Imperial Health Plan

Members: 1-800-838-8271

Providers: 1-00-830-3901

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SCAN Health Plan

Members: 1-800-559-3500

Providers: 1-888-705-7226

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Wellcare Health Plan

Members: 1-866-999-3945

Providers: 1-866-999-3945

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PROVIDER PORTAL

amdclg

AMDC, IPA

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awhclg

American West Healthcare Soluctions

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DMIPA

Doctor's Managed, IPA

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eipalg

Evergreen, IPA

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smg

Stewart Medical Group, IPA

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upilg

United Physicians International, IPA

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ymalg

YOUnity Medical Affiliates, IPA

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CONTACT US

OUR ADDRESS

If you need assistance or would like more information, please contact us at the following:

(626) 943-7465, Monday - Friday: 9am - 5pm

(626) 458-8051

info@sandsmanagement.com

S&S Management, Inc. 1032 S. Garfield Ave. Alhambra, CA 91801

COMPLIANCE CONCERNS

Compliance Hotline (anonymous): 1-855-662-SAFE

Compliance Reporting Website (anonymous): www.safehotline.com/SubmitReport, Company ID: 4237443530,

Compliance Mailbox: 4compliance@sandsmanagement.com