MANSOQ RCM & insurance
Check network membership by site, service and date
Avoid assuming every branch of a provider has the same direct-billing participation.
Current source · source reviewed · 5 min read
Before you begin
- Patient coverage with an applicable class/network.
- Current provider-site and service-scope evidence.
1. Identify the actual site
Select the facility/branch providing the care. Brand-level membership is insufficient because sibling branches may have different participation.
2. Review specialty and service scope
Check the network membership for the service, specialty, effective period, tier and direct-billing capability relevant to this encounter.
3. Compare contract and policy
Confirm the membership aligns with the patient’s policy/class and provider contract. Resolve conflicts through the work queue and source evidence.
4. Preserve the historical membership
When participation changes, retain the earlier effective membership and open any continuity review required by the configuration. Do not delete the site from historical policies.
Removal is not an automatic denial
The operator guide describes network removal as a continuity review. Contract expiry alone does not establish immediate loss of every existing member’s entitlement.
Read the precise outcome
The selected network and site outcome must be read alongside eligibility and benefit decisions. A network label is not a substitute for the actual service-date result.
Troubleshooting
One branch is eligible and another is not
Compare the site identifiers, service scope and dates. Request the network owner’s evidence instead of copying the sibling branch’s answer.
Source evidence
References are pinned to the private MANSOQ source repository. Repository access is required to open these links.