Days are certified based on medical need, not just diagnosis
Bill totals are obtained every five days for early notification
Written notification when bill total meets 50% of specific deductible
We assist with predeterminations
Written notification of trigger diagnoses to claims and reinsurance
Written notification of results on biopsies and medical tests
We do a daily open case review for potential high dollar and case
management
Repricing referrals are generated in UR
We identify potential savings
Our nurses are assigned by TPA, providing clear, open lines of
communication
All of our nurses are available by individual e-mail addresses
We can assist the TPA in setting up in-house UR
We customize services to meet changing and challenging client
needs
