When you're ready for managed care that balances the needs of your employees with a healthier bottom line, see us for a detailed plan that includes:
Provider Bill Review
This premier service combines current state fee schedule revisions with the latest database for usual and customary charges to eliminate excessive and duplicate charges. In addition to insuring your regulatory compliance, bill review identifies billing infractions that might normally get lost in the shuffle, while customized rules make it easy to identify and divert predefined bills for specific injuries and procedures to a nurse case manager for review and challenge.
Preferred Provider Organization Networks
Our unique PPO strategy grants you special access to numerous national, regional and proprietary networks. And we can customize each specific program by incorporating client-negotiated provider discounts. This mosaic approach provides optimal network coverage with maximum savings, giving you more for less.
Diagnostics
By using a national diagnostic discount/scheduling network for MRIs, CTs, EMGs and more, we work with 3,200 facilities across the country to save our clients an average of $785 per referral.
Specialty Bill Review
Specialized medical procedures can lead to exorbitant bills and excessive charges. This unique service uses robust data from more than 20 public and proprietary sources to provide the legal, medical and financial bill analysis required to ensure a re-pricing review that’s fair, reasonable, defensible and unique to your jurisdiction.
Integrated Pharmacy Program
Prescription drug costs now account for 12% of total medical claims. And they're on the rise, climbing faster than general medical inflation. Through Comp RX — an integrated pharmacy program linked directly to our proprietary claims software, we can capture "first fills" and adjudicate pharmacy claims directly online when they're dispensed. Studies show that first fills account for 80% of all pharmacy costs; therefore, any successful program must capture this event.
Our adjusters also have the ability to look up data from the pharmacy, doctor and patient via one screen, bringing together all the data required to make informed and cost-effective decisions. With this system in place, we can view drug information and pricing, recent reject history, recent claim history, and approve medications — all in real time, delivering the best care at the lowest cost.
Utilization/Disability Management
At CCMSI, we realize that proactive nurse case management can lower cost, improve care and help injured employees return to work sooner. Whether you use our proprietary nurse case management resources (available in select offices) or a preferred partner, we'll work with the nurse involved to establish and oversee a medically appropriate and cost-effective treatment plan to achieve optimal results.
Analysis and Savings Reports
For the best results, you need objective and definitive data to measure the success of your managed care program and fine-tune future performance. That's why we offer a full library of reports, allowing you to gauge any number of variables.