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The foundation of MedPOINT Management's management model is Utilization Management. The Utilization Management staff is committed to working in concert with IPA physicians to monitor referrals, PCP visits, inpatient admissions and ancillary service utilization in a manner that is consistently beneficial to patient, provider and IPA. Our staff does more than simply monitor and record medical utilization data—they track and trend the data on a daily basis. This level of attention to our patient population affords MedPOINT Management the opportunity to act quickly and decisively with an action plan to address anomalies in the utilization data. Upon request to the UM department, providers and members can obtain copies of the criteria used for decision making by the groups.
It is the philosophy of MedPOINT Management that to be successfully managed, medical utilization must be proactively managed rather than merely recorded and reported on a quarterly basis. One of the most important determinants of a successful utilization management program is the level of physician involvement in the management process and the ease with which the UM program aligns with the IPA physicians’ practice patterns and habits.
UM decisions are made only on appropriateness of care and service and existence of coverage. The IPAs do not specifically reward practioners or other individuals for issuing denials of coverage or services
Key features of MedPOINT Management Utilization Management services:
| Development and administration of policies and procedures that meet regulatory compliance |
| Design and implementation of referral authorization, precertification, concurrent review, and case management processes |
| Authorization review processes that are customized to meet the needs of specific health plans, IPAs and local markets |
| Case management and concurrent review done in conjunction with IPA physicians |
| Communication of clear, concise guidelines for Primary Care Physician roles and responsibilities |
| Constant research and development of innovative, cost-effective and medically sound utilization management processes |
| On-site education and training to physicians and staff about program requirements, compliance issues, implementation processes and reporting guidelines |
| Medical Director training and education |
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