Utilization reviews are conducted by our nurses in accordance with Milliman Care Guidelines (MCG) and your plan benefits. We also work with our Claims department to ensure that patients receive the most appropriate care at an acceptable cost.

Our Disease Management program focuses on helping members with chronic illnesses that can be improved through healthy behaviors and routine medication. This program also invests in preventive care, reaching out to at-risk members and recommending preventive services.

Our Case Management services focus on coordinating care for members in-need and bridging the gaps in communication between members, providers and facilities. This results in timelier health services, better health outcomes for patients, and higher cost savings for employers.

This is a supplemental case management service for customers who already have a utilization management vendor. As part of this program, HealthComp works with your vendor to ensure that we add value to your case management solution and avoid redundancies.

Our Cancer Awareness program identifies candidates for cancer awareness campaigns and reaches out to them to complete cancer screenings. Target demographics are identified by analyzing age and gender.

Our Dialysis Claims Management program is an outreach effort to encourage members who are receiving dialysis to enroll in Medicare (when eligible). This can reduce dialysis costs to 125% of Medicare for eligible members.

Our ER Solutions program reaches out to members who have recently used ER services and educates them on alternative care solutions. Steering members towards alternative solutions can lead to significant cost savings.

Our nurses design personalized programs for expectant mothers to promote a healthy pregnancy and delivery. We also provide employers with reports and notifications of pregnancy-related high-dollar claims.

Our Utilization Management team engages in a number of practices to control costs to the employer, including negotiating in- and out-of-network rates, reviewing claims for medical necessity, and in-network steerage (when appropriate).