Case Management

This is an add-on optional module that helps identify members who are at risk for diseases. Case Management will assist you and your case managers with education, monitoring, and active management of your at-risk population. Care plans that are designed to achieve a specific outcome provide standard sets of services and assessments. These services and assessments are provided to patients based on their individualized health conditions.

Case Management tracks the progress of members under report variances from the Care Plans. You can identify your case management population through various portals. These portals include claims analysis, authorization analysis, and recommendations calling for primary or specialty care providers and patient Health Risk Surveys. You can define the level of case management through assessments. Or, scores from the assessments will highlight the level of necessary case management. Monitoring is accomplished by comparing claims paid and authorizations issued with services identified in care plans. Case Management uses interactive visual cues to indicate overdue services.