Precertification
Client specific services for prior authorization are selected on the onset. Our clinical team determines medical appropriateness utilizing evidence-based medical review criteria. Our team also examines the proposed site of service and utilization of in-network based providers/facilities specific to the members' plan.
Concurrent Review
We conduct an intensive review for members at an inpatient setting or a request for transfer to a different level of care. We determine the severity of illness or disability, coordinate, and facilitate the plan of care, communicate possible alternatives, and ensure timely delivery of services following discharge, or transition planning. We assure the 4 R's are in place: services occur at the right time, the right setting, the right amount, and the right cost. Following discharge from the facility, our team contacts the patient to make sure they understand and adhere to the prescribed medical treatment plan. If needed, a referral is made to a nurse case manager.
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Superior Service Excellence AHG’s delivery of health engagement to customers is unique: All services with the exception of on-site support are delivered by highly-trained and experienced team members at our corporate headquarters
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Members and clients are served through cross-functional teams under the leadership of RN’s which allows us to meet all service and clinical needs of our customers