At Innovative Care Management, our primary concern is that the our clients' enrollees receive the highest quality care at the most manageable cost. The first step towards this goal is taken in our Preauthorization and Utilization Management program. The medical review process of this department allows us to provide a number of services helpful to both the patient and our client, such as:

• Patient Advocacy - In every situation, we want patients to receive the treatment they need. We make a strong effort to help patients know what questions to ask their doctor, encourage communication between their care providers, and even help coordinate care so that patients receive the treatment and medical equipment they need, when they need it.
  
  
• Medical Necessity Determinations - Through our review process, we are able to make certain that expensive procedures and services are the most appropriate treatment for a patient to receive, and that there are no better alternatives.
  
  
• Preferred Provider Verification - As a part of the process, we always confirm that a preferred provider is being used if possible. Most benefit plans have a preferred provider network that could help the patient by providing a discounted rate for services and possibly a higher benefit rate if used.
  
  
• Plan Exclusion Identification - A number of benefit plans have exclusions for certain procedures, and as a part of our review process, we can check on the patient's benefits, and give notification prior to a procedure of any potential problems with coverage.
  
  
• High Risk Screening - While reviewing procedures, we are always trying to identify patients who may have high-risk diagnoses, so that we may refer them to one of our other programs in which they can receive personal attention from one of our nurses to ensure that they are receiving the treatment they need, and taking preventative measures to reduce the risk of future complications.
  
  
• New Technology Research - In cases where new or experimental procedures or technology are requested, we will research information and determine if it is medically appropriate and covered under the benefit plan.

• Patient's Full Name
• Member ID Number
• Subscriber's Full Name
• Group Name / Name of the Employer or Union Local that supplies the insurance
• Group Number
• Patient Address and Phone Number
• Patient Date of Birth
• Diagnosis with ICD-9 codes
• Procedure with CPT codes
• Name of Facility
• Name of Doctor
• Date of Service (if scheduled)
• Copy of Insurance Card
• Chart Notes / Clinical Information