Benefit Determination
The CHCS Services care coordinator completes an independent assessment in the client’s home or facility in order to expedite and verify benefit eligibility. The client’s health condition, ADL loss, and cognitive status are evaluated and a personalized plan of care is recommended. The nurse will identify available community resources and Medicare services if needed when developing the plan of care.
Pre-authorization of Services
Rising claims costs are a serious problem within the Senior Market Insurance Industry. To this end, CHCS Services works together with our clients to help find affordable and reasonable solutions to manage your claims. Pre-authorization of services is one way to control how often the most costly services are accessed by your members. Pre-authorization helps determine if the indicated service meets the medical necessity requirements of the policy. Pre-authorization data is provided to enable your claims adjusters the ability to verify rate and service levels.
Care Plan Development
The CHCS Services plan of care process focuses on ensuring the delivery of appropriate care in the most cost effective manner. Information from the benefit eligibility assessment combined with additional information from physicians, providers and client support systems are incorporated in the care plan.
The CHCS Services plan of care summarizes the service recommendations (including informal support system when appropriate), the purpose of each service recommendation, available Medicare services, additional community resources, proposed frequency and duration of services, cost of services, payment sources and identification of all medical equipment necessary in the delivery of care.
Discharge Planning
CHCS Services believes an effective care management process includes the integration of discharge planning at the inception of care to enable evaluation of progression to goals over the life of the claim. The care manager works with the client, family, physician and provider in determining the proper care plan and maximizes appropriate services through Medicare to assist the member to reach optimal independence faster while decreasing policy exposure.
Information and Referral Services
CHCS Services provides comprehensive information and referral services through elder care specialists. Our specialist’s help members make informed decisions about:
- Care options
- Assistance with locating nursing homes, assisted living facilities, home health care options, retirement communities and adult day care centers anywhere in the nation
- Identification and referrals to other local community based resources
Provider Network
CHCS Services maintains a nationwide provider network.
Our analytics prove that hard savings are realized when network care services are arranged to preserve benefit dollars and reduce out of pocket exposure. This is accomplished by establishing preferred provider relationships and contracted rates with numerous health care delivery organizations.
Nationwide Provider network services are available as:
- Full network access as part of care management core services
- Full network access incorporated into claims adjudication model
- Full network access to your insured population at a PMPM rate