A claimant's experience and quality of care is at the heart of everything we do.
Care management means providing the right care at the right time by the right provider. This requires getting involved early on in the claims process to find high-quality, medically correct services for claimants to ensure they are getting the care they need.
Our care management team achieves this by advocating for our claimants—interacting with physicians and other health care practitioners, providers, insurance carriers, billing offices, and claims processors—and making the quality of care they receive our highest priority.
We also recognize that care needs can and do change over time and regularly verify that the appropriate care is being performed to best meet claimants' needs, help reduce unnecessary costs, and protect against the possibility of fraud.
Acting as individual care managers for long term care claimants and their families, our care coordinators are registered nurses (RNs) who offer an unbiased resource for families to consult with at the often difficult time of finding the right care for a loved one. Our team of compassionate, care-centered experts provide the following services:
Fast and accurate claims processing, for claimants, powers of attorney, family members, and providers ensures continuity of care for enrollees when it's time to use their benefits. At the same time, we recognize the importance of establishing controls that prevent misuse in order to protect the program, carrier, and claims experience as a whole.
We're committed to maintaining this balance between monitoring the integrity of our enrollees' claims while providing claims processing services that meet the highest standards of quality. Our services include: