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The annual Business Insurance directory of utilization review/case management service pro-viders lists companies that offer utilization review and/or case management directly to members of employer-spon sored group plans on behalf of the employer.
Business Insurance defines utilization review as reviewing inpatient and/or outpatient hospital care and services through programs such as preadmission certification, concurrent hospital treatment review, length of stay determination, discharge planning, case management, retrospective review and second surgical opinions.
Case management is defined as providing planning and monitoring throughout the course of high-ri sk illnesses, including discharge planning, onsite or telephone case review and/or patient referrals.Listings begin with the company name and address. Financial/statistical information includes: total 1996 gross revenues, followed by the actual dollar amount of revenues generated by utilization review and/or case management services.
Listed next is the percentage of revenues attributable to three sources: utilization review and/or case management services pro vided directly to employers; utilization review and/or case management services to insurance companies, managed care providers and TPAs; and other services.
Staff information lists total staff assigned to utilization review and/or c ase management, including a breakout of total professional staff members and staff members on retainer. Staff numbers are provided in full-time equivalents, except for those on retainer.
Business volume is represented by the number of utilization review/case management clients; covered lives, including employee benefit plan and workers compensation lives served; total acute care hospital admissions reviewed and the percent of proposed admissions/cases divert ed for outpatient care. All figures provided are for 1996.
The text section of each listing includes the year the company began offering utilization review or case management services and the parent company, if applicable. Utilization Review Accreditation Commission certification is noted as URAC certified.
Specific utilization review and case management services the company provides are described under frequent and occasional services. Next, the types of medi cal services reviewed/cases managed are provided.
Branch offices are other locations performing utilization review, followed by compensation, the method used to bill for services. Names and titles of principal officers and a contact complete the listings.
This directory is published as an editorial service to our readers. There is no charge for companies to be listed. Information reported is based on each company's response to a BI questionnaire. Although every effort is made to publish complete and accurate listings, BI is unable to verify all information.