In Addition to Reference Based Pricing Services
MCM has partnered with reference-based pricing programs to provide pre-pricing navigator services prior to treatment. This service is available to clients that use referenced-based pricing reimbursement models instead of hospital PPO networks.
To help mitigate uncertainty that can arise between plan members, payors and providers when utilizing reference-based pricing methodologies, MCM has implemented this proactive approach. Utilization management requirements are necessary to engage the Nurse Navigator Program. This will initiate discussions with the provider and member about the quality and pricing outcomes available for the medical treatment.
Services included are:
- Estimated pricing disclosed to payor, provider and member prior to hospital service being rendered for elective procedures.
- Urgent cases are reviewed retrospectively in accordance with applicable UM protocols.
- CM is initiated if necessary.
- A dedicated customer service team manages requests.
- A patient advocacy center manages provider inquiries or disputes.