Corporate Managed Health Services

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HEALTHCARE RISK MANAGEMENT

A Complete Solution

Corporate Managed Health Services (CMHS) is our managed care firm with 25 years of experience. Our services save clients time and money, while helping ensure their employees are receiving quality treatment. When a member needs medical care, our case managers immediately act as the employee’s “advocate.” We communicate with the doctors to be sure all procedures and treatments are appropriate and ensure a smooth experience with a positive outcome for the member.

Our services are administered by nurses and physician advisors – setting us apart from other managed care programs. Our case managers are experienced professionals who understand healthcare in the self-insured arena – which is crucial for reviewing and analyzing the medical treatment needs of each patient. They are also experienced in effectively and compassionately communicating with patients before, during and after the treatment process.

In addition to overseeing the healthcare process for employees, we help our clients control costs by identifying, analyzing and managing potentially high dollar claims. By having this program in place we save our clients more than 20% in heathcare costs annually.

Cost-Saving Methods:

  • Pre-certification: The best practice in medical claims management is to identify the claim before it happens. We apply Milliman & Roberts guidelines (The Gold Standard) to all requests by doctors and hospitals. These guidelines enable us to achieve HMO-like results and ensure only medically necessary and appropriate requests for service are pre-certified.

  • Middle & Large Case Management: Hospital stays and ongoing conditions are monitored to ensure that optimal care is being provided throughout the treatment process.

  • Retroactive Review: Our clinically driven medical claims review system is designed to un-bundle and detect fraudulent or abusive charges once the claim is received. This process ensures only quality dollars are spent. Projected annual savings for this program are between 3% and 12% of your total healthcare expenditures.

  • Point of Service Discount Negotiation: Obtains discounts for individual services rendered to our client’s employees, without compromising the quality of care received.

  • Pharmasense Program: Our exclusive program designed to manage the high cost of Specialty / Bio-Tech pharmaceuticals.

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