Advancements
in medical technology and the discovery of new health care treatments have made
the question of medical necessity more complex than ever. To ensure that every
case receives comprehensive utilization review, MedBen performs this service
through American Health Holding, Inc.
(AHH), a firm
specializing in medical management services.
AHH’s Utilization Management Program uses
nationally recognized criteria, plus Registered Nurse Reviewer assessments of
psychological, social and medical factors, to determine the appropriateness
of inpatient and outpatient admissions. In
certain situations, the reviewer may interact with the attending physician to
agree on treatment plans and appropriate lengths of hospital stay. Patients are
monitored throughout their hospital stay to assure that quality and
appropriateness of care is maintained.
All utilization management staff members are RNs with a minimum of six years clinical experience and managed care backgrounds. A panel of board-certified physicians oversees the program. Should additional consultation be necessary, an external panel of 250 medical specialists can be accessed from the following medical fields:
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| This attention to detail results in reduced health costs and assurance that the best alternative treatments have been assessed. | |
For more information about utilization review, please e-mail our marketing department at marketing@medben.com.