DIRECTORY OF UR PROVIDERS AND CASE MANGERS ( P )

P
PHA Review
1350 Old Bayshore Highway, Suite 570, Burlingame, Calif. 94010; 415-375-5800; fax: 415-375-5820
Utilization Review/Case Management
1996 revenues
UR/case mgmt. revenue$2,600,000
UR/case mgmt. direct to employers20%
Svcs. to managed care/insurance providers80%
Staff
Total UR/case management employees14
Professionals10
Clients
Total19
Covered lives/reviewed admissions
Employee benefit plan lives served161,000
Diverted for outpatient treatment9%
UR/case mgmt. services since: 1989.
Parent: Pacific Health Alliance.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, review of lab work, patient education, retrospective review, second surgical opinion, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Occasional services: Free prescreening, hospital bill audits.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric.
Branch offices: Fresno, Merced, Sacramento, Stockton and Turlock, Calif.
Compensation: $1.10 to $1.95 per employee per month.
Officers: Lawrence Cappel, CEO; Metta Shields, director; Robert Mackler, executive vp; Danna Janatpour, director; Brian Thornberry, director-marketing.
Contact: Brian Thornberry.
PRNA Services
12000 Ford Road, Dallas, Texas 75234; 972-247-0592; fax: 972-406-8903
Utilization Review/Case Management
1996 revenues
Total gross revenue$4,500,000
UR revenue$1,000,000
Case mgmt. revenue$1,000,000
UR/case mgmt. direct to employers10%
Svcs. to managed care/insurance providers30%
Other services60%
Staff
Total UR/case management employees10
Professionals10
UR/case mgmt. employees on retainer49
Clients
Total31
Covered lives/reviewed admissions
Workers compensation lives served1,400,000
Acute care inpatient admissions reviewed500
Diverted for outpatient treatment35%
UR/case mgmt. services since: 1985.
Parent: Amzim Inc.
Frequent services: Preadmission certification, length of stay determination, onsite and telephone case management, review of lab work, retrospective review, hospital bill audits, outpatient service predetermination, written reports.
Occasional services: Concurrent hospital treatment review, discharge planning, patient education, second surgical opinion, outpatient psychiatric and substance abuse services, referrals to alternative settings.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability.
Compensation: $150 to $2,500 per case; $65 to $85 per hour.
Officers: Colin Herlitz, president; Liz Minch, Karen Davidson, executive vps; Marc Semmelmann, vp-sales/marketing; Bruce Wood, CFO.
Contact: Marc Semmelmann.
Parman & Associates Inc.
2211 Lake Club Drive, Suite 105, Columbus, Ohio 43232-3155; 800-742-1354; fax: 614-575-9399
Utilization Review/Case Management
1996 revenues
Total gross revenue$1,500,000
UR revenue$300,000
Case mgmt. revenue$1,200,000
UR/case mgmt. direct to employers85%
Svcs. to managed care/insurance providers10%
Other services5%
Staff
Total UR/case management employees24
Professionals18
UR/case mgmt. employees on retainer151
Clients
Total75
Corporate/institutional employer clients60
Covered lives/reviewed admissions
Workers compensation lives served50,000
Acute care inpatient admissions reviewed1,000
Diverted for outpatient treatment10%
UR/case mgmt. services since: 1984.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, retrospective review, hospital bill audits, outpatient service predetermination, referrals to alternative settings, written reports, life care planning, vocational services.
Occasional services: Review of lab work, patient education, second surgical opinion, outpatient psychiatric and substance abuse services.
Medical services reviewed/managed: Chiropractic, rehabilitation, workers comp/disability.
Branch offices: Cincinnati, Cleveland and Toledo, Ohio. Can also provide national service through Unified Care Managment (UCM).
Compensation: $30 to $180 per case; $72 per hour.
Officers: Jamie L. Parman, president; Karl Shuster, director-marketing/operations; Melissa Wiseman, director-UR; Christine Moranda, director-case management; Mary Kolks, manager-vocational department.
The Precertification Center/Health Benefits Management Inc.
P.O. Box 898125, Camp Hill,
Pa. 17089-8125; 717-232-0946;
fax: 717-232-1713
Utilization Review
1996 revenues
Total gross revenue$3,046,196
UR revenue$3,021,896
UR/case mgmt. direct to employers99%
Other services1%
Staff
Total UR/case management employees37
Professionals26
UR/case mgmt. employees on retainer2
Clients
Total890
Corporate/institutional employer clients888
Covered lives/reviewed admissions
Employee benefit plan lives served485,177
Workers compensation lives served1,130
Acute care inpatient admissions reviewed36,038
Diverted for outpatient treatment6.3%
UR services since: 1984.
Parent: Pennsylvania Blue Shield/Capital Blue Cross.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, second surgical opinion, outpatient service predetermination, outpatient psychiatric and substance abuse services, FMLA certification.
Occasional services: Retrospective review, referrals to alternative settings.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric, hospice, skilled nursing facility, home health, private duty nursing.
Compensation: $0.95 per contract.
Officers: Jerry E. Boyer, president; Elizabeth A. Galitski, vp-operations; Yvonne M. Fry, manager-precertification programs; Peggy Belfonti, manager-disability programs.
Preferred Health Plan Inc.
10180 Linn Station Road, Suite B-200; Louisville, Ky. 40223; 502-339-7500; fax: 502-339-8716
Utilization Review/Case Management
1996 revenues
Total gross revenue*$2,145,000
UR/case mgmt. revenue*$249,000
UR/case mgmt. direct to employers6%
Svcs. to managed care/insurance providers6%
Other services88%
Staff
Total UR/case management employees3
Professionals3
Clients
Total26
Corporate/institutional employer clients26
Covered lives/reviewed admissions
Employee benefit plan lives served32,280
Acute care inpatient admissions reviewed2,995
UR/case mgmt. services since: 1989.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, review of lab work, retrospective review, referrals to alternative settings, written reports.
Occasional services: Telephone case management, patient education, second surgical opinion, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services.
Medical services reviewed/managed: Group health, rehabilitation, psychiatric/substance abuse, pediatric.
Compensation: $1.75 to $2.00 per employee per month.
Officers: Paula S. Barr, president/CEO; Nancy Redmon, director-medical resource management; Dennis Stovall, CFO; Mary S. Stivers, director-operations.
Contact: Nancy Redmon.
**Estimate.
Preferred Mental Health Management Inc.
401 E. Douglas, 3rd Floor, Wichita, Kan. 67202; 316-262-0444; fax: 316-262-0003
Utilization Review/Case Management
1996 revenues
Total gross revenue$2,300,000
UR/case mgmt. revenue$2,300,000
UR/case mgmt. direct to employers100%
Staff
Professionals6
UR/case mgmt. employees on retainer2
Clients
Total52
Covered lives/reviewed admissions
Employee benefit plan lives served800,000
Acute care inpatient admissions reviewed2,200
Diverted for outpatient treatment7%
UR/case mgmt. services since: 1987.
Frequent services: Preadmission certification, length of stay determination, discharge planning, telephone case management, patient education, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services.
Occasional services: Concurrent hospital treatment review, review of lab work, retrospective review, referrals to alternative settings, written reports.
Medical services reviewed/managed: Psychiatric/substance abuse.
Compensation: $2.65 to $4.75 per employee per month.
Officers: Les Ruthven, president; Courney Ruthven, executive vp/CFO; Wayne Isaac, senior vp/COO.
Private Healthcare Systems
1100 Winter St., Waltham, Mass. 02154; 617-895-3144; fax: 617-895-6848
Utilization Review/Case Management
1996 revenues
Total gross revenue$110,000,000
UR revenue$47,000,000
Case mgmt. revenue$4,000,000
UR/case mgmt. direct to employers5%
Svcs. to managed care/insurance providers41%
Other services54%
Staff
Total UR/case management employees428
Professionals187
Clients
Total26
Corporate/institutional employer clients6
Covered lives/reviewed admissions
Acute care inpatient admissions reviewed681,839
Diverted for outpatient treatment62%
UR/case mgmt. services since: 1985.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, telephone case management, review of lab work, patient education, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports, high-risk maternity screening, medical necessity review.
Occasional services: Discharge planning, onsite case management, retrospective review.
Medical services reviewed/managed: Group health, chiropractic, rehabilitation, psychiatric/substance abuse, pediatric, home health, infusion therapy, physical therapy.
Branch offices: Irvine, Calif.; Chicago.
Officers: Richard Belloff, president/CEO; Peter George, COO; Mark Bloomberg, chief medical officer; J. Rick Newsome, CFO; Richard Kwei, interim chief information officer.
Contact: Maryjane Frascino, director-marketing/communications
PRO-West, A Professional Review Organization
10700 Meridian Ave. N., Suite 100, Seattle, Wash. 98133-9075; 206-364-9700; fax: 206-368-2419
Utilization Review/Case Management
1996 revenues
Total gross revenue$10,200,000
UR revenue$9,586,332
Case mgmt. revenue$613,668
UR/case mgmt. direct to employers90%
Svcs. to managed care/insurance providers10%
Staff
Total UR/case management employees67
Professionals48
UR/case mgmt. employees on retainer200
Covered lives/reviewed admissions
Employee benefit plan lives served4,380,000
Workers compensation lives served10,000
Acute care inpatient admissions reviewed57,149
Diverted for outpatient treatment1%
UR/case mgmt. services since: 1974.
URAC certified.
Frequent services: Preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, onsite and telephone case management, review of lab work, patient education, retrospective review, second surgical opinion, hospital bill audits, outpatient service predetermination, outpatient psychiatric and substance abuse services, referrals to alternative settings, written reports.
Occasional services: Free prescreening.
Medical services reviewed/managed: Group health, dental, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric, massage therapy, physical therapy, home health, DRG validation, technology assessment, prenatal care coordination, quality improvement services, data analysis, disease management.
Branch offices: Anchorage, Alaska; Boise, Idaho; Plano, Texas; Lynnwood, Wash.; Cheyenne, Wyoming.
Compensation: Per employee per month; per case; per hour.
Officers: Joseph Palermo, chairman; John W. Daise, CEO; Michael Garrett, executive director; Dr. Jonathan Sugarman, medical director-health care quality/principal clinical coordinator; Dr. Jeanette Ruby, corporate medical director.
Contact: Julianne E. Collier, account executive.
Professional
Case Management Consultants Inc.
P.O. Box 940338, Maitland,
Fla. 32794-0338; 800-647-6347;
fax: 407-647-1395
Utilization Review/Case Management
1996 revenues
Total gross revenue$730,000
UR revenue$100,000
Case mgmt. revenue$630,000
UR/case mgmt. direct to employers30%
Svcs. to managed care/insurance providers70%
Staff
Total UR/case management employees28
Professionals1
UR/case mgmt. employees on retainer27
Clients
Total31
Corporate/institutional employer clients6
UR/case mgmt. services since: 1993.
URAC certified.
Frequent services: Discharge planning, onsite and telephone case management, review of lab work, patient education, free prescreening, retrospective review, second surgical opinion, outpatient service predetermination, referrals to alternative settings, written reports, certified life care planning, chronic diesease management, pharmaceutical UR, vocational case management, independent medical exam, provider negotiation.
Occasional services: Concurrent hospital treatment review, length of stay determination, hospital bill audits, outpatient psychiatric and substance abuse services, high risk maternity, peer review.
Medical services reviewed/managed: Group health, dental, chiropractic, rehabilitation, psychiatric/substance abuse, workers comp/disability, pediatric, occupational therapy, physical therapy, home health.
Compensation: $65 to $125 per hour.
Officers: Belinda E. Brice, president; Harry Greene, director-customer relations; Kathie Maloney, secretary.