MED TAC - Managed care and discounted services





	Managed Care & Discounted Services Click on subject in menu below to jump to it Managed Care and Discounted Services Self-funding Administrative Services Management Consulting Services MANAGED CARE AND DISCOUNTED SERVICES Return to Top of Page MANAGED CARE PROVIDERS Healthcare Value Management, Inc.: Superior network for New England based companies. ProAmerica Network MVPPO Sloans Lake Managed Care Many others to suit the geographical needs of any employer. UTILIZATION MANAGEMENT - An ongoing review and analysis of claims by a skilled team of medical technical and business oriented professionals provide a proper balance between cost-containment and appropriate quality health care. HOSPITALIZATION REVIEW Pre-admission Review Urgent/Emergency Review Concurrent Review CASE MANAGEMENT REVIEW Cost effective, quality and necessary care in the most appropriate and humane setting for high risk and long term conditions NON-HOSPITAL ANCILLARY SERVICES REVIEW Review for necessity and appropriateness CHIROPRACTIC PODIATRIC REVIEW PRESCRIPTION DRUG PLANS For employee access to appropriate and cost effective prescription drugs Prescription Card Programs Mail Order Drug Plan SELF-FUNDING ADMINISTRATIVE SERVICES Return to Top of Page ADMINISTRATIVE SERVICES - Enjoy reduced charges from those of HMOs and Commercial Insurers while including: Preparation and design of plan communications-booklets, identification cards, summary plan documents Issuance of Explanation of Benefits and checks providers and beneficiaries Provision of all necessary forms, customized if required Recommendations of claims payment account funding levels Assistance in establishment and maintenance of claim payment bank account Filing of claims and information with stop loss carriers CLAIMS MANAGEMENT that reduces cost on average by 18% versus an industry average of 5% Paying in accordance with plan description Coordinating benefits with other carriers Editing for duplicate payments Determining subrogation applicability Requesting independent provider audits COMPETITIVE STOP-LOSS Insurance prices via access to multiple insurance carriers to limit exposure with guaranteed maximum rates. MANAGEMENT CONSULTING SERVICES Return to Top of Page MANAGEMENT REPORTS - Avoid year-end surprises with accurate, timely and understandable monthly reports that keep you informed of the financial and utilization performance of your organization's benefit plan. Actual to budgeted financial performance Diagnosis analysis Hospital admission and provider analysis Cost containment analysis ANALYSIS of your organization's utilization patterns to focus on problem areas. PLAN DESIGN INITIATIVE tailored to your organization's needs. Recommendations for solutions to specific problems Promotion of preventive care Removal of impediments to early detection and care Enhancement of outpatient care Recommendation of preferred provider relationships based on benefit utilization, provider performance, geographic analysis Recommendations for the effective use of specific and aggregate stop-loss polices