MEDICAL CASE MANAGEMENT
Our health care analytic tools enable us to identify and address any potential issues or discrepancies in medical care and expenses, allowing us to work with healthcare providers to manage costs and ensure high-quality care for our clients. By utilizing prior authorization, case management, concurrent review, discharge planning, and retrospective review, we can address any issues that arise throughout the healthcare journey and ensure that our clients receive optimal care that is cost-effective.
Our fully integrated Medical Case Management programs and services cover a wide range of healthcare needs, including chronic disease management, catastrophic injury rehabilitation, workplace injuries, complex care coordination, and more. We work closely with patients, healthcare providers, and employers to provide comprehensive care that prioritizes the patient's well-being and delivers positive clinical outcomes.
At PREMIA, we are committed to providing top-quality Medical Case Management services that optimize patient outcomes, reduce healthcare costs, and improve the overall healthcare experience. Our expertise, industry knowledge, and cutting-edge technology enable us to deliver the highest levels of service to our clients, ensuring they receive the best possible care at all times.
PREMIA uses robust health care analytic tools, to assure quality of care and cost management through prior authorization, case management, concurrent review, and discharge planning and retrospective review.
Our commitment to comprehensive Medical Case Management extends across multiple domains:
Medical File Review: Our team of expert clinicians and professionals reviews medical documentation and analyzes patient information to ensure appropriate diagnosis, treatment, and medical necessity.
Medical Bill Review & Auditing: We examine medical bills for accuracy, identify any discrepancies or overcharges, and negotiate with healthcare providers to secure reduced payments on behalf of our clients.
Medical Case Management: Our case managers work directly with patients, families, and providers to coordinate care, assist in care transitions, and ensure the most effective and efficient use of healthcare resources.
Peer Review: We enlist a network of independent medical professionals to provide unbiased, third-party evaluation of clinical care and medical decision-making to assure the highest quality of care for our clients.
Pharmacy Claim Audits: Our team conducts rigorous audits of pharmacy claims to identify and correct any billing inaccuracies or discrepancies, while ensuring that medications are medically necessary and cost-effective.
Telephonic Medical Case Management: We offer remote telephonic case management services to help support patients and families, facilitate care coordination, and provide continuity of care.
Additionally, our physician advisers work closely with our team of Medical Case Managers to ensure that patients receive appropriate care, reduce unnecessary medical expenses, and optimize patient outcomes. By leveraging our extensive network of healthcare experts and industry experience, PREMIA delivers high-quality Medical Case Management services that reduce costs, improve patient outcomes and increase satisfaction for our clients.
PREMIA’s extensive experience across the healthcare landscape, centered in independent clinical and medical bill audit services and in the financial management of health care organizations, can benefit Private and Public Health Care organizations to win the pursue of cost reduction and quality.
Delivery of Services
At PREMIA, we understand the complexities of today's healthcare industry and are committed to ensuring that our Medical Case Management programs are tailored to meet the unique needs of each client. By providing custom, patient-centered solutions that prioritize quality and affordability, we enable Private and Public Healthcare organizations to achieve their goals in cost reduction and enhanced patient outcomes.
By adhering to strict confidentiality requirements, while striving to obtain a positive outcome for the patient in the most cost-efficient manner, PREMIA case managers can:
▪Confirm assignment within minutes
▪Provide Initial Case Activity Form on all full medical case management assignments
▪Contact patient prior to his hospitalization and physician on the same day of hospitalization
Our health care professionals include board-certified physicians, registered nurses, certified case managers, and internationally recognized experts in health care management, many of whom have direct experience in the insurance industry.
PREMIA also contracts with board-certified physician advisers who assess patients’ medical conditions to determine medical necessity, appropriateness of treatment plans, and whether the quality of delivered care meets evidence-based community standards.