Health
Associates of America has a proven track record of delivering
Utilization Review Services that improve quality of service
for the patient, while using the least restrictive site of
service, resulting in substantial savings in behavioral health
care claims.
URAC
and MNRO
As part of Health Associates of America's ongoing quality
assurance program, our clinical staff meets on annual basis
to evaluate it's utilization review program. This program
evaluation ensures that Health Associates of America meets
the Utilization Review Accreditation Commissions (URAC) Utilization
Management Standards as delegated entities for the health
insurance companies for which it provides services.
For information about our UR staff click here.
As a Louisiana Licensed Medical Necessity Review Organization
(MNRO), this annual program evaluation also ensures that Health
Associates of America meets the Louisiana MNRO standards.
UR
Policies and Procedures
Our
success in delivering Utilization Review Services is based
on our in-house professional clinical expertise and proprietary
manual which documents our diagnostic criteria, policies and
procedures.
Our
UR manual provides the guidelines on diagnosis and medical
necessity, patient services, admission / pre-service reviews,
concurrent review, appeals and retroactive/post service reviews.
The
UR manual also details the most recent clinical data for least
restrictive site of service appropriate for the patient, i.e.
partial hospitalization, intensive out-patient, residential
and individual out-patient services.
UR
Case Management
Our
case management service monitors and assists high risk, relapse
patients by working with their providers, families and community
resources.
UR
Provider Relations
Our
experience since 1980 with the provider community allows for
a collegial working relationship. Our clinical and psychiatric
staff meet with providers to discuss diagnostic and treatment
issues to improve patient care.
UR
Reports
We
provide in-depth reports which document the number and type
of admissions, diagnosis, services requested and approved,
types of appeals and results, type of plan, (i.e. fully insured,
PPO, HMO and ERISA cases). The report documents cost savings
by each type of plan. Clients can choose to receive administrative
reports on a quarterly, semiannual and/or annual basis.
Client
Success
Let
us do for you, what we did for Blue Cross and Blue Shield
of Louisiana:
“Hildago
Health Associates designed, implemented and has managed our
behavioral health utilization review services since 1986.
They have worked with the provider community to assure that
our subscribers and their family members receive the most
appropriate service in the least restrictive level of care
and at the most affordable prices. They have accomplished
this by utilizing our provider networks or by developing a
statewide, specialized mental health PPO network and negotiating
fair and favorable provider rates or reimbursement to manage
all levels of care. Their case management system has reduced
our (IP) stay from high double digits to a low single digit
stay. This has resulted in an average annual savings for our
500,000 members of over $2,000,000 per year.” -
Kathyrn M. Sullivan, CPA, CLU - President and CEO Blue Cross
Blue Shield of Louisiana.*
*Used
With permission |
