Unique provider profiling identifies high quality, cost effective providers. Service and utilization parameters trigger claim review. A multi-tiered review process is binding on all providers. Claims are processed and passed on to payors. This is a true managed care program that helps health plan sponsors manage utilization and quality in a potentially costly area of specialty care.
All providers meet strict credentialing guidelines.
This gives the employer sponsors of health plans the bargaining power they individually lack. Through our efforts, communities enjoy the benefit of more control over the cost and quality of their health care. Our experienced professionals guide the development process from initial employer meetings and data analysis to network development, program and plan design development. We utilize state of the art measurement tools to provide our coalition management teams with reports they can use to make decisions, influence behaviors, control costs and improve quality. We can help coalitions interpret health care data and translate that into action.