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