Heritage provides a complete medical management program using EZCap and CareContact systems for prior authorization, concurrent review, case management and member health management services. We are committed to making it easier for physicians and providers to do business with us. In fact, network physician input is instrumental in our medical management process and requirements.
At Heritage, we provide medical care through our integrated physician and provider networks. Our focus is on quality of care with an emphasis on wellness and prevention. Through our physician networks and medical management staff, we help manage complex illnesses and support members with chronic conditions.
Heritage’s medical management services include:
Concurrent Review - Case managers work with hospitals, rehabilitation and skilled nursing facilities to ensure timely and appropriate care. They coordinate the discharge process and assist with the arrangement of home care, follow-up appointments and medical equipment at discharge.
Case Management - Our qualified case managers assist our members and physicians with planning, implementation, coordination, monitoring of care and evaluating options and/or services to meet a member’s individual health care needs. Prior Authorization - All referral and authorization requests are completed in three calendar days following CMS and TDI guidelines. Nationally accepted care guidelines are also utilized in the authorization process. Copies of care guidelines used to make any authorization decision are available to providers upon request. In addition, a list of prior authorizations is reviewed and approved by our network physicians. Contracted providers can submit electronic authorization requests through MC-NET and view the authorization requests online.
Medical management staff can be contacted directly with authorization and medical management questions. An on-call case manager is available after business hours and on weekends to assist with medical services needs.
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