ENCOMPASS Medical Management Services
It can be difficult for a health plan's members to determine if a hospitalization, test or outpatient procedure is the best solution for a health problem. Unnecessary care creates health risks, disrupts daily life and drains members' individual plan benefits. It also places unnecessary financial strain on the overall health plan.
ENCOMPASS' approach to Medical Management facilitates medically appropriate and necessary health care services. Our nurses apply proprietary screening criteria to each case, evaluating medical necessity and treatment setting. If criteria are not met, cases are referred to one of our 180 provider consultants across the country for a determination of medical necessity.
Customizing Solutions
At ENCOMPASS, we work with each client's health plan requirements to build a customized profile from our comprehensive Medical Management and Care Coordination solutions. Our Medical Management services can include:
Improving Outcomes
For more than 20 years, our commitment to supporting the right care at the right time in the right setting has created successful partnerships with members, clients and health care providers. Because we work to improve the quality of medical care received as well as eliminate unnecessary treatment, health care costs generally decrease due to improved outcomes.
To help ensure our services conform to best practices in the industry, our Medical Management program has been continuously accredited since 1992 by URAC, a respected accreditation organization. Additionally, ENCOMPASS is licensed or certified as required to provide Medical Management services in all 50 states.
Demonstrating Results
ENCOMPASS' effective strategies deliver results with a strong return on investment. Through weekly, monthly, quarterly and annual reports, we demonstrate value through decreased utilization, documented savings, and provider activity. For additional value, major reports include analysis with recommendations and comparison to book of business and market trends.