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Utilization Management

Empower health outcomes via medically necessary and appropriate care.

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Challenge: Balancing Quality Care and Cost-Effective Outcomes

Establishing effective and efficient medical services while providing quality care with cost-effective outcomes for members presents a challenge in today's healthcare landscape.

Expert Assurance Solution

Solution: Integrated Techniques for Optimal Utilization Management

Our team and systems evaluate the medical necessity and determinants of medical services provided by participating and non-participating physicians, hospitals, and other ancillary providers. Our goal is to analyze the effectiveness of treatments for each patient before, during, and after care delivery. We monitor performance to improve the efficiency and quality of care delivery while controlling costs and reducing waste. By employing integrated techniques, we help you stay ahead of soaring healthcare costs and keep your member population healthy.

Our Utilization Management Services Include:

Prior authorization entry

Evaluation appropriateness of medical service(s)

Retrospective reviews

Authorization mailings

Prospective and concurrent claim reviews

See What Our Clients Are Saying

The team at HealthAxis is extremely helpful and informative. Their knowledge base for ideas, problem solving, and delivery are done so with outstanding quality and readiness. HealthAxis recognizes our concerns and they address them clearly and concisely by demonstrating superb product and system knowledge which earns our trust in their abilities.

Sharon Abney

Chief Operating Officer
InsuranceTPA.com Administrators
Over the course of our 22-year relationship, HealthAxis has provided exceptional service and support to our team. We value the collaboration and knowledge that their team brings to the table to address our concerns timely and efficiently.

Jennifer Moore

Vice President of the Group Health Program
NTCA–The Rural Broadband Association
HealthAxis has consistently met the Medicare supplement processing needs of our organization since January 2014. We can rely on them to process timely, error-free results. They maintain open communications and are very responsive to our processing and/or programming needs. We have asked for many processing upgrades over the years, and we have never had a request be denied or not be completed within time constraints. Questions are given top priory and solutions to issues are presented without prompting. Consistency is paramount, with minimal changes to the staff that supports us over the years. Overall, the relationship has been one in which we can truly trust they will meet the needs of our organization and policyholders.

Kevin Roberts

Sr. Vice President of Insurance Operations
United Commercial Travelers of America

The HealthAxis platform is a user-friendly system that allows for a smooth communication between each application. This allows for multiple departments to handle member customer service in an efficient manner.

Freedom Health and Optimum HealthCare

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