To effectively adjudicate claims and determine appropriate reimbursements per the terms in our contracts, Wexford Health will apply our WexCare automated claims system, which processes claims in accordance with Medicare and Medicaid standards and generally accepted health care industry practices.

We based WexCare on “free world” claims processing software and then customized it for correctional health care. The system's ability to integrate utilization management, claims, and provider contract data improves the contract’s operational efficiencies and reduces operating costs in several ways.

Wexford Health’s team of experienced claims processors, combined with our WexCare software, helps clients avoid being victimized by identifying and flagging billing practices most commonly used to commit inadvertent (or intentional) health care fraud.

Wexford Health has a comprehensive process in place to ensure that our health care professionals are legally eligible to perform their clinical duties.  We will ensure that our employees meet all applicable State and federal licensing, certification, and/or registration requirements.

To ensure quality care and fulfill federal and regulatory obligations, we use an extensive credentialing process that meets the requirements of both the NCCHC and the Joint Commission.  Our Credentialing Department gathers data and verifies education and licensing, while our Human Resources Department obtains written or verbal references for professional candidates.  To facilitate the process, Wexford Health uses PRIVplus™, an industry-standard software package that tracks all aspects of credentialing and re-credentialing.  

It is the responsibility of each qualified health care professional to maintain his or her licensure, certification, or registration.  Additionally, once hired, we require our QHCPs to bring any changes in their credential status to Wexford Health's attention.  We keep copies of all current nursing and physician licenses on file in the health care unit office.  In all cases, we restrict our health care professionals from performing tasks beyond those permitted by their credentials.

Unless required more frequently under our contract, Wexford Health’s corporate credentialing team reverifies licensure and conducts an NPDB review for each applicable practitioner biannually (every two years).  We provide these updates to the facility where the employee works, for inclusion in his/her personnel file.