Products and Services
Solutions to reduce health care costs
Administrative Services
- Access to a contracted medical provider network
- Practitioner recruitment
- Provider relations
- Credentialing
- Contracting and network development
Quality Assurance
- Outcomes assessment surveys
- Patient satisfaction surveys
- Medical chart review audits
- Objective outcomes assessment based on the provider
- Subjective outcomes assessment based on the member
Utilization Management (UM)
- Pre-authorization services
- Concurrent and retrospective Medical Necessity Review (MNR)
- Provider profiling
- Peer-to-peer review model
- Continuous quality improvement (CQI)
- Out-patient Satisfaction Survey and Patient Satisfaction Questionnaire (PSQ)
Claims Services
- Out of Network (OON) Expedited Agreement
- Claims adjudication
- Repricing
- Single source claims submission to the payor
- Out of network fee negotiation
- Claims Audits