Early alert system - identifying potentially high-risk, high-dollar cases

When focused attention and specialized care cases are identified and managed, it can help control costs and provide appropriate, quality care.

CareAllies' Utilization management solution can help. As a leader in utilization management, CareAllies' has experience from easy-to-access, no hassle inpatient review to case referrals, outpatient care and other programs. We can help plan participants navigate a complex health care system to help ensure access to appropriate, quality care while controlling costs. We have invested in a wide range of clinical and technological resources to provide worry-free claims determinations that are consistent, fair, clinically sound, and comply with government regulations.

How it works for you

Our utilization management services provide easy access into plan participant's benefits. Our health care professionals can help callers understand options and serve as guides in a complicated health care system. Over our years of experience, we have been recognized and awarded accreditation from URAC, an independent organization whose mission is to ensure consistent quality of care for payors and consumers.

Features

Our services cover the full spectrum of acute and sub-acute inpatient and outpatient reviews. Our approach addresses costs throughout the health care delivery system and is engineered to integrate seamlessly with our other health care management program, case management, for maximum impact. Our key features provide clinically sound, internally developed guidelines combined with nationally recognized guidelines to help ensure focus, consistency and appropriate care.

	Acute
	Medical/Surgical Behavioral Health Maternity

	Sub-acute care
	Medical rehab Skilled nursing facility Chemical dependency rehab

	Residential
	Behavioral Health Physical, speech and occupational Therapies

	Clinic or facility
	Imaging; diagnostic and surgical procedures Chiropractic services Cardiac rehab Programs Behavioral Health Therapies Behavioral health; Partial hospital Stay/day treatment

	Home
	Physical, speech and occupational therapy Nursing visits; includes RN/LPN aide and hospice

We Make a Difference.

We have the clinical expertise and state-of-the-art technology necessary to deliver targeted utilization management services that can reduce hassle for employees while helping to identify potentially high-risk, high-dollar cases. Yielding positive health outcomes for plan participants and improved savings for you. We are uniquely equipped to integrate utilization management with other health and productivity management programs for an even greater financial impact.

You'll have access to our TPA toolbox to facilitate claims, case management and reporting capabilities. Find out how much better it can be with CareAllies.

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