Offering Innovative Care Management Solutions

Third Party Administration

Whether you require state-of-the-art claims adjudication services or utilization management services, HS1 can offer innovative care management solutions for your organization.

We've redefined the meaning of "Administrative Services Only" (ASO)

It used to be that the term "ASO" applied only to claims adjudication services. Payors were forced to contract with multiple, unrelated third-party vendors in an effort to piece together an effective managed care program. As you'll discover, HS1 offers a totally integrated medical risk management solution that redefines the meaning of "ASO" services.

From full claims adjudication and comprehensive utilization management to provider network services, our ASO services are available on a bundled or unbundled basis, so you can tailor a cost-effective care management program that meets your financial goals and the needs of your insureds.

Whether you are a provider group, a government entity, a specialty network taking medical risk, HS1 is a unique boutique TPA that can help you reduce your overall medical and administrative costs.

HS1 can assist in providing any one of these high quality administrative services, at very attractive rates: 

Administrative Services

  • Beneficiary / Eligibility
  • Premium Billing
  • Claims EDI, Adjustment & Settlement
  • Compliance & Government Relations
  • Enrollment
  • Accounting & Finance
  • Regulatory Forms / Filing & Reporting
  • Regulatory Application Submission
  • Integrated IT Technology
  • Member Services
  • Operational Support
  • Premium Billing & Collection
  • Web Portal for Providers
  • Provider Services

HS1 can also provide the following medical management services at very attractive rates:

Utilization Management

  • Authorization & Referrals 
  • Population Informatics 
  • Concurrent Review 
  • HEDIS Reporting 
  • Disease Management 

Quality Assurance

  • Grievance & Appeals
  • Credentialing 
  • Risk Management

Medical Management Services

HS1 offers a comprehensive array of medical management products and services. 

We have experience in the medical management of over 1,000,000 lives comprising  Medicare, Medicaid and Commercial lines of business.

Medical Direction

  • HS1 Chief Medical Officer and Medical Directors have extensive managed care backgrounds
  • They insure that the highest quality of care is delivered in the most cost effective manner
  • They promote direct involvement with Physicians, PCPs, Hospitals and Discharge Planners
  • Specialty-oriented Peer Review Committees oversee episodes of care, grievances, credentialing,  etc.

Disease Management (DM) / Population Informatics

  • Utilizes evidence based clinical guidelines
  • Evaluation of high-risk patients for appropriate DM programs
  • Identification of members at risk of substantially impaired health status and potentially more serious problems
  • Case / Disease managers follow patients concurrently with PCP
  • Care is directed to appropriate specialist
  • Reduces costs associated with chronic illnesses
  • Provides educational information to patients and family on how to control or reduce chronic conditions

Authorization Department

  • Treatment Auths. -  24 / 7
  • Benefit & eligibility verification
  • Timely referrals to specialists and hospital for inpatient and outpatient services

Concurrent Review

  • Coordination of all inpatient care - from hospitalization to discharge

Case Management

  • Upon discharge, Nurses manage the total continuum of care
  • Insure that the most appropriate, cost effective & timely treatment is provided

Credentialing

  • Primary Source Verification
  • In-house Peer Review
  • Integrated with QI program
  • Comprehensive record keeping & documentation

Quality Improvement

  • Evaluation of Providers for Regulatory Compliance
  • Perform Medical Record and Site Visit Audits
  • Information trending / tracking
  • Quality Improvement Projects
  • Benchmarking & Corrective Action Plans