UTILIZATION MANAGEMENT

Registered nurses-supported by MedWatch Medical Director - assuring appropriate, quality care with special attention to cost containment.

Components of MedWatch Utilization Management:

• Pre-certification: Inpatient & Outpatient
• Client-specific Pre-Cert requirements…per SPD & TPA preference
• Nationally recognized clinical guidelines applied to all clinical decisions
• Medical necessity assessments
• Network steerage or negotiations
• Concurrent review
• Discharge planning
• MOM Program: Maternity Obstetric Monitoring
• Inpatient case cost oversight and documentation
• Early notifications regarding high-dollar/stop-loss cases
• Outpatient testing and biopsy results reporting
• Internal panel of practicing specialist MD reviewers & national specialty review panels performing expert advisory support
• Free screening for Case Management opportunities & HBA audits
• On-Site Medical Management Services available
• Private-label programs available

MedWatch's EXPERT CLINICAL TEAM IS SUPPORTED BY MedWeb™ – OUR PROPRIETARY CLINICAL MANAGEMENT SYSTEM SOLUTION…automating data flow and connectivity between members, providers, TPAs and stop loss carriers…and improving service.

MedWeb™ features:

• Automated high-risk case identification and notifications to TPA and MGU/carriers
• Fully integrated Utilization Management, Case Management & Disease Management clinical data exchange
• Automated Member & provider letter library -  flexible and customizable
•  Secure interface for authorization transmission to claims system
• MedWeb™ Client Portal allowing secure real-time access to clinical work, case status and reporting
• HIPAA, PHI and HITECH compliant