MedCareOne is a comprehensive managed care organization that works thru strategic alliances with TPA’s to provide a coordinated effort in managing healthcare dollars.

Through a relationship with the TPA and Client, MedCareOne assists with lowering healthcare costs for the patient, client, provider, and TPA. MedCareOne’s objective is to follow a process that is clinically sound, respects the patient’s rights, provides the best healthcare for the claims dollars spent, and comply with all URAC Standards.

MedCareOne recognizes that 20% of individuals incur in excess of 80% of total healthcare costs. Because of this, MedCareOne takes a pro-active approach to target and manage these conditions.

Reporting:
One of the cornerstones of controlling healthcare costs is the availability of information. This allows for decisions to be made on an informed and educated basis. At MedCareOne, you will receive regular management reports on every individual in each group, as well as case management details posted on a secure web-site for the TPA’s use.

Revenue Sharing Program:
MedCareOne offers revenue/profit sharing with it’s TPA partners. This allows for the client and TPA to benefit from the aggressive, pro-active approach taken by MedCareOne.

MedCareOne offers a full compliment of services, including but not limited to:

• Pre-Certification
  The process of validating the medical necessity of a proposed acute hospital admission or emergency treatment.
• Case Management
  A requirement by some health benefit plans to have any outpatient surgical procedure pre-certified for medical necessity. Upon notification of a planned out patient surgery, MedCareOne will validate the medical necessity of such procedures.
• Medical Peer Review
  A review of physician bills, treatment plans, medical or surgical fees for medical necessity, and/or usual and customary fees.
• Rapid Nursing Assessment
  Patient, physician and or family members are cont acted to obtain a rapid but complex assessment of a Participant’s medical needs, projection of care and costs. A brief summary describing a patient’s current medical status and recommendations is submitted.
• Negotiated Savings for Out-of-Network Claims
  Negotiations are attempted on large dollar claims prior to or during the time-frame that services are rendered at out-of-network facilities.
• Health Index Reports
  Health screenings are performed to determine health risks. This includes blood analysis, vita signs, weight assessment and completion of a health risk questionnaire. A comprehensive report of the findings is mailed to the participant.