We draw on our deep industry and extensive functional expertise, to implement custom and fully integrated Medical Case Management programs and services, improving patient outcomes and reducing healthcare costs.
PREMIA uses robust health care analytic tools, to assure quality of care and cost management through prior authorization, case management, concurrent review, and discharge planning and retrospective review.
▪Our Medical Case Management programs focuses on the following key services:
▪Medical File Review
▪Medical Bill Review & Auditing
▪On-Site Case Management
▪Pharmacy Claim Audits
▪Telephonic Medical Case Management
PREMIA’s extensive experience across the healthcare landscape, centered in independent clinical and medical bill audit services and in the financial management of health care organizations, can benefit Private and Public Health Care organizations to win the pursue of cost reduction and quality.
Delivery of Services
At PREMIA, each Medical Case Management program is customized to our clients’ specifications. Our Case Management team ensures that client cases are reviewed and managed by a team of professionals dedicated to optimizing healthcare services and maximizing client discounts. Along the way, PREMIA’s proprietary cost management practices are applied to the charges.
By adhering to strict confidentiality requirements, while striving to obtain a positive outcome for the patient in the most cost-efficient manner, PREMIA case managers can:
▪Confirm assignment within 2 hours
▪Provide Initial Case Activity Form on all full medical case management assignments within 48 hours of referral
▪Contact patient prior to his hospitalization and physician on the same day of hospitalization
▪Contact employer within 24 hours
Our health care professionals include board-certified physicians, registered nurses, certified case managers, and nationally recognized experts in health care management, many of whom have direct experience in the insurance industry.
PREMIA also contracts with board-certified physician advisers who assess patients’ medical conditions to determine medical necessity, appropriateness of treatment plans, and whether the quality of delivered care meets evidence-based community standards.