Risk Management Services Partner with Professional Medical risk Managers

Administrative Services

• Full Claims Adjudication
• Capitation, FFS Claims Payment or Pricing
• Benefits & Eligibility Verification
• Contestation & Third Party Recoveries
• Regulatory Compliance & Government Relations
• Benefit Plan Design

Provider Network Services

• Access to a Panel of Contract Providers
• Network Development (Area or Group Specific)
• Provider Relations & Education
• Credentialing

Utilization Management/Quality Improvement

• Medical Authorizationa and Referrals
• Concurrent Review & Case Management
• Disease Management & Preventative Care
• Pharmacy / Formulary Management
• Hospital Admitting Panel
• Population Management Informatics