UTILIZATION MANAGEMENT

Fully integrated with our operations and with 20 years of experience, we have the in-house clinical resources and expertise to deliver the UM services, outcomes and cost management you expect.
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Cost Containment

With a strong emphasis and continued commitment to cost containment, we have invested in a staff of 55 Utilization Management professionals, 30 of whom are nurses – making cost containment one of our core competencies.

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Disease Management

HealthComp’s team of medical specialists utilizes individual healthcare information to evaluate our clients' medical risks and develop customized and proactive care plans for your members to improved health and provide significant long-term cost savings for your company.

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Care Advocate

The Care Advocate Program collaborates with other UR vendors for that much-needed "personal touch" often lacking in the healthcare industry. Our experienced nurses develop close, personal relationships with their patients, something unique from the health insurance standpoint. All to assist in coordinating care so that the patient can focus on becoming well.

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Case Management

Our case management program helps control the escalating costs of serious illnesses and/or chronic diseases by helping members understand their condition and receive the most effective services. We ensure they're delivered in the most cost-effective manner available for maximized cost savings and member satisfaction.

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Mommies-2-B

Mommies 2-B (M2B) is a program to help expecting mothers better understand and manage their pregnancy. Our in-house nurses provide members with tailor-made pregnancy programs to provide support to mommies during this exciting time so they and their babies have the greatest chance for a healthy pregnancy and delivery.

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Fee Negotiation

With cost-management solutions being critical in today’s insurance industry, HealthComp’s Utilization Management Department has established a Provider Fee Negotiation Unit to secure discounts on provider billings and keep out-of-network costs reasonable so members can get the care they need without worry.

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Utilization Review

HealthComp's Utilization Review is a comprehensive process that ensures medical necessity based on Milliman Care Guidelines. Our onsite Registered Nurses also ensure that services are provided in accordance with Plan benefits.