Products & Services

The Value Proposition of Health Utilization Management Services is decreased claim trends associated with costly acute care admissions, inpatient rehabilitation, skilled nursing and outpatient services.

Health Utilization Management Services include:

• Web based Precertification Requests
• Prospective, Concurrent, Retrospective Review
• Automatic Continued Stay Review
• Discharge Assistance
• Medical Necessity at most appropriate / cost- effective level
• Cross referrals to case and disease management
• Reviews conducted by RNs and MDs
• Hospital, surgical, outpatient care
• Live phone coverage 24 x 7
• Physician to physician communication on all questioned cases
• DOL compliant non-certification / appeals
• Employee Education Assistance

The goals of the Health Utilization Management Program include:

• Assure that services are medically necessary, high quality and provided in the appropriate, cost effective setting.
• Identification of shock-loss cases that will meet reinsurance thresholds
• Promotion of timely discharge and transition to lower levels of appropriate care
• Identification of early referrals for case and disease management
• Promotion of higher member satisfaction rates