OUR SERVICES

How We Can Help

CASE MANAGEMENT

It's All About the Patient

Case management is an often under-utilized, but valuable asset. Those who embrace case management have the benefit of dedicated nursing support (24/7) to address questions, fill prescription, and attend appointments. We help patients restore order to their lives, adopt new patterns and behaviors in light of their condition, and increase the overall likelihood of a complete recovery. Members have access to knowledgeable, compassionate nurse advocates to advise them and minimize the fear and unknown that healthcare has become.
With proper case management, members are admitted less, have lower pharmacy cost, and avoid emergency room visits which results in better medical outcomes and saves the employer money.

PRIOR AUTHORIZATION

Provides Real-Time Information

We believe in the prior authorization and precertification of services. This is not meant to be a barrier to care as we rarely say no. What we achieve through this process is real-time insight as to what is happening with each patient at any time. We use this knowledge to guide patients to the best available care. If great patient outcomes can be assured in multiple places, why not use the most cost effective?
Access to prior authorization data provides rich analytical support and allows the employer to accurately predict costs prior to claims being submitted and paid, facilitating better management of cash flow.

UTILIZATION REVIEW

Protecting Your Employees and Your Resources

We evaluate the standard of care available and contrast this with national standards. When a patient’s needs exceed the capacity of the local system or a better outcome can be reasonably expected elsewhere, we work directly with providers to secure the most appropriate care from the appropriate source. Our experience is that the highest quality outcome is also the most cost effective.

MEDICAL CLAIMS AUDIT

Validation of What You Pay For

Every plan needs an effective “check and balance” system to manage expense and risk. We establish normative cost expectations around more substantive medical situations. When a case presents, we conduct an extensive review and uncover areas of plausible savings. We negotiate directly with the processors and providers to ensure the expense is reasonable and appropriate.
All claims audits are completed by Board Certified physicians with specialty designations(s) relevant to the patient’s diagnosis. Savings are based purely on medical necessity and not a compromise to the standard of care. To date, we have not had a patient balance-billed.