DIRECTORY OF UR PROVIDERS AND CASE MANGERS ( N )

N
NCM Services
15326 Alton Parkway, P.O. Box 16361, Irvine, Calif. 92713; 714-453-5122;
fax: 714-453-5220
Utilization Review/Case Management
1996 revenues
Total gross revenue$420,000
UR revenue$120,000
Case mgmt. revenue$300,000
UR/case mgmt. direct to employers25%
Svcs. to managed care/insurance providers75%
Staff
Total UR/case management employees17
Professionals13
Clients
Total8
Corporate/institutional employer clients8
Covered lives/reviewed admissions
Employee benefit plan lives served100
Workers compensation lives served1,000
Acute care inpatient admissions reviewed750
Diverted for outpatient treatment30%
UR/case mgmt. services since: 1993.
Parent: CaseCo.
Frequent services: Concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, patient education, free prescreening, second surgical opinion, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Occasional services: Preadmission certification, review of lab work, retrospective review.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric.
Branch offices: Redondo Beach, Calif.
Compensation: $1 to $1.50 per employee per month; $100 per case; $75 to $90 per hour.
Officers: Sally Swenson-Mazur, president; Mark Fernandez, director-clinical operations.
Contact: Sally Swenson-Mazur or Mark Fernandez.
NHA Review Services Inc.
770 S. Post Oak Lane, Suite 445, Houston, Texas, 77056; 800-950-7528; fax: 713-888-1986
Utilization Review/Case Management
1996 revenues
Total gross revenue$418,609
UR/case mgmt. revenue$418,609
UR/case mgmt. direct to employers15%
Svcs. to managed care/insurance providers85%
Staff
Total UR/case management employees5
Professionals5
Clients
Total42
Corporate/institutional employer clients12
Covered lives/reviewed admissions
Employee benefit plan lives served27,907
Workers compensation lives served676
Acute care inpatient admissions reviewed664
Diverted for outpatient treatment15%
UR/case mgmt. services since: 1989.
Parent: National Healthcare Alliance Inc.
Services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, retrospective review, second surgical opinion, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric.
Compensation: $1.25 to $1.50 per employee per month.
Officers: Robert Woolfolk, CEO; Melvin Thorne, president; John Baird, medical director; Beverly Kracht, director.
National Health Services Inc.
9200 Shelbyville Road, Suite 700, Louisville, Ky. 40222; 800-762-7360;
fax: 502-339-8057
Utilization Review/Case Management
1996 revenues
Total gross revenue$15,900,000
UR revenue$12,334,724
Case mgmt. revenue$3,463,676
UR/case mgmt. direct to employers22%
Svcs. to managed care/insurance providers77%
Other services1%
Staff
Total UR/case management employees140
Professionals107
UR/case mgmt. employees on retainer19
Clients
Total65
Corporate/institutional employer clients4
Covered lives/reviewed admissions
Employee benefit plan lives served3,579,330
Workers compensation lives served35,024
Acute care inpatient admissions reviewed312,083
Diverted for outpatient treatment4.5%
UR/case mgmt. services since: 1984.
Parent: United Payors & United Providers.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, patient education, free prescreening, retrospective review, outpatient service predetermination, referrals to alternative settings, written reports, occupational medical management, claims audit review, high risk maternity screening and review, nursing home review, long-term care facility case mix review, ancillary therapy review, disease management, demand management, specialty referral review.
Occasional services: Onsite case management, review of lab work, second surgical opinion, hospital bill audits, outpatient psychiatric and substance abuse services.
Medical services reviewed/managed: Group health, dental, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric.
Branch offices: Dallas.
Compensation: $1.20 to $2.20 per employee per month; $100 to $125 per case; $80 to $200 per hour.
Officers: Anthony Pino, CEO; Rick Dankworth, Barbara Freeman, executive vps; Christie Sturzebecker, senior vp; Joe Bruno, CFO.
Contact: Michelle Runyon, vp-operations.
National Rehabilitation Consultants of Colorado Inc.
2460 W. 26th Ave., Suite 440C, Denver, Colo. 80211; 303-433-2223;
fax: 303-433-9909
Case Management
1996 revenues
Total gross revenue$800,000
Case mgmt. revenue$800,000
Case mgmt. direct to employers25%
Svcs. to managed care/insurance providers75%
Staff
Total case management employees12
Professionals9
Case management services since: 1978.
Frequent services: Onsite case management, written reports, evaluation services.
Medical services reviewed/managed: Workers comp/disability, no-fault auto.
Branch offices: Colorado Springs.
Compensation: $70 to $80 per hour.
Officers: R.W. Nelson, president; Tim Vermeer, case services director.
National Utilization Management Corp.
7301 N. 16th St., Suite 201; Phoenix, Ariz. 85020; 602-371-3860;
fax: 602-371-3885
Utilization Review/Case Management
1996 revenues
Total gross revenue*$2,000,000
UR revenue*$1,400,000
Case mgmt. revenue*$600,000
UR/case mgmt. direct to employers8%
Svcs. to managed care/insurance providers92%
Staff
Total UR/case management employees34
Professionals34
UR/case mgmt. employees on retainer60
Clients
Total110
Covered lives/reviewed admissions
Employee benefit plan lives served450,000
Workers compensation lives served70,000
Acute care inpatient admissions reviewed11,000
Diverted for outpatient treatment20%
UR/case mgmt. services since: 1990.
Parent: USA Managed Care Organization Inc.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, telephone case management, retrospective review, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Occasional services: Onsite case management, review of lab work, second surgical opinion, hospital bill audits.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric, high risk maternity program.
Branch offices: Austin, Texas.
Officers: George E. Bogle, chairman/CEO; Constance Lambert, president; W. Joseph Martin, CFO; Laura Dickson, senior vp/COO; Dr. James Gerace, medical director.
Contact: Constance Lambert, 800-354-2464.
**Estimate.